IAMSENT Client Intake & Housing Agreement
  • IAMSENT Client Intake & Housing Agreement

  • Client Intake Information

    Please complete all fields below
  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Gender
  • How soon do You Need Placement?
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Move in Date *
     - -
  • Housing Agreement

    Please read and acknowledge the terms below.
  • I understand and agree to the following: 

    - IAMSENT Transtional Housing provides shared housing with supportive services. 

    - I Agree to pay the required monthly program fee on time each month. 

    - I understand this is transitional housing, not permanent or long-term residence. 

    - I understand that curfew is enforced unless otherwise approved by staff. 

    - I agree to participate respectfully in all shared living conditions and expectations. 

     

  • Rules and Conduct Agreement

  • I agree to follow all IAMSENT rules, including: 

     

    Drugs, Alcohol & Safety Rules

    - No Alcohol or drugs allowed on property 

    - No weapons allowed on property. 

    - No violence, threats, harrasement, or racial slurs (Use of Racial Slurs, hate speech, discriminatory launguage, harrasement, or intimidaton of any kind is strictly prohibited) 

    - Tampering with smoke detectors, cameras, or safety equipment is prohibited 

    - No fighting allowed - automatic termination of agreement. 

     

    Cleanliness & Hygiene Rules

    - Must shower daily and wear clean clothes. 

    - No food or drinks allowed in bedrooms (water only) 

    - All clients must clean the bathroom (shower and toilet) after each use. 

    - Clients must keep personal belongings in assigned areas 

    - No clothes or items hanging form bunks (includes hats/coats). 

    - Bedrooms musy be made upon waking up 

    - 15-minutes time limit in bathroom unless medically necessary. 

     

    House Rules & Conduct 

    - Shoes need to be removed before entering house 

    - Only Staff allowed in kitchen area 

    - No hanging out in front of the house - commone area and backayard only 

    - Smoking area is a in backyard only (must pick up cigarette butts). 

    - One container allowed per person (18 gallon max) - if doesnt fit goes to lockers 

    - No microwave use after 9 PM. 

    - Headphones required when using electronics (phone,tablet,laptop).

    - No storage or food in the fridge or cabinets unless approved. 

     

    Curfew & Security 

    - Doors and gates locked at 11PM (Mon-Thurs). 

    - Doors and gates locked at 12 AM midnight (Fri-Sun). 

    - No overnight guest allowed. 

     

    Program Participation 

    - Must participates respectfully in shared living condtions. 

    - Failure to follow rules results in : "24-hour" or "48-hour" leave from the property, OR 

    - Immediate termination from the program depending on the violation. 

     

    I understand that violation of any major rule may result in immediate discharge from IAMSENT program.  

  • No-REFUND AGREEMENT

  • I Understand and agree to IAMSENT Transtional Housing No-Refund Policy: 

    - All program fees, including the monthly progrmam fee, is non-refundable under any and all circumstances 

    - If a client chooses to leave early, no portion of the program fee will be returned. 

    - If client is terminated from the program for violating rules, no portion of the program fee will be returned. 

    - Fees are paid to secure placement, meals, utilities, facility upkeep, and administrative support 

    - not based on length of stay. 

    -By signing this agreement, I fully acknowledged that IAMSENT does not provide refunds, prorated refunds, or credits of any kind. 

     

    I understand that once payment is made and my placment is secured, the fee is final and non-refundable 

     

  • Damage Responsibility Policy

  • IAMSENT Transitional Housing is committed to mainatianing a safe, clean, and functional living environment for all clients. To ensure our facilities remain in proper condition, the following policy outlines reponsibility regarding accidental or intentional damage to IAMSENT property. 

     

    1. Overview 

    Clients are reponsible for the care of all IAMSENT property located wihthin thei assigned rooms and shared community areas. While we understand accidents can happen, any damage caused by a client- whether intentional or accidental-must be repaired or replaced at the client's expense. 

     

    2. Reporting Rerquirements

    If damage occurs, clients must immediatelty notify IAMSENT staff. 

    Staff will then: 

    - Document the incident 

    - Assess the damage 

    - Determine the appropriate repair or replacement method 

    Failure to report damage may result in addiditonal charges 

     

    3. Repair and replacement Process 

    To maintian facility standards, all repairs will be handeled directly by IAMSENT or an approved vendor. 

    This ensure safety consistency, and compliance with building guidlines 

    Clients may not attempt repairs on their own unless specifically approved in writing. 

     

    4. Client Financial Responsibility 

    Clients are finacially responsible for: 

    - The cost of repair labor

    - The cost of parts or materials 

    - Replacement costs when items cannot be repaired 

     

    A written notice of charges will be provided. The amount must be paid within 7 days or will be added to clients next balance. 

     

    5. Payment & Billing 

    Damage charges may be: 

    - Added to the clients upcoming rent invoice, or 

    - Billed as a separate charge due wihtin 7 days 

     

    Unpaid charges may affect continued elgibility for the program. 

     

    6. Examples of Billable Damage 

    This includes, but is not limited to: 

    - Broken beds, frames, or furniture 

    - Damaged walls, doors, locks, or windows

    - Stained or destroyed mattresses

    - Damage to appliances or shared area items 

    - Tampering with smoke detectors, security devices, or facility equipment. 

     

    7. Disputes 

    If a clients believes the charge is incorrect, they may request a review within 48 hours or receiving the notice. 

    IAMSENT will reassess documentaition and provide the final decision 

     

     

  • Program Participation Agreement

  • I understand and agree that:

    IAMSENT Transitional Housing is a supportive housing program designed to provide temporary housing and community support services.

    Participation in the program is governed by program policies, participant agreements, and community living standards.

    Participants are expected to follow program rules, safety requirements, and staff instructions.

    IAMSENT may suspend or discharge participants when necessary to protect the safety, wellbeing, and orderly operation of the program.

    Violations involving violence, threats, drug activity, property damage, harassment, or conduct that endangers others may result in disciplinary action or discharge from the program.

    I understand that continued participation in the program depends on compliance with program expectations and community standards.
    Participant Acknowledgment

    By signing below, I acknowledge that I have read, understand, and agree to comply with the policies, expectations, and community standards of the IAMSENT Transitional Housing Program.

  • Media Consent Form

  • This section is optional. It does NOT affect your abiility to stay at IAMSENT.

    I give permission to IAMSENT Transtional Housing to use my photograph, video, voice, and/ written statement for: 

    - Program update 

    - Social Media Content 

    - Website Content 

    - Fundraising Materials 

    - Community Outreach 

    - Success Stories 

     

    I understand: 

    - My participation is voluntary 

    - IAMSENT will respect my privacy 

    - I can request to have media removed at any time by submitting a written request. 

    - This consent can be revoked at any time. 

    If you do NOT want your photo, video, or statements used, simply leave the signature below blank 

  • Chore & Responsibility Agreement

  • All IAMSENT clients are required to participate in maintaining a clean, safe, and respectful living environment. By joining the program, you agree to the following reposibilites: 

     

    You must complete the weekly chore assigned by staff. 

     

    Chores may include: 

    - Sweeping 

    - Mopping 

    - Cleaning common areas 

    - Taking out trash 

    - Bathroom cleaning rotation 

    - Yard/patio cleanup (if assigned) 

     

    - Your assigned chore must be completed on the day and time discussed by staff. 

    - Failure to complete chores may result in loss of privileges, removal from food program, and/or program termination. 

    - Repeated refusal or failure to cooperate with cleaning expectations may result in immediate discharge from program. 

  • IMMEDIATE TERMINATION AGREEMENT

  • I understand and agree to the following Immediate Termination Policy for IAMSENT Transtional Housing: 

    - IAMSENT reserves the right to terminate my stay immediately, without prior notice, If I violate major program rules. 

    Immeidate termination may occur for:

    - Physical violence or threats

    - Harrassment, intimidation, or aggresive behavior

    - Drug or alcohol use on property

    - Possesion of weapons

    - Tampering with security cameras, smoke detectors, or safety equipment.

    - Stealing from residents or staff

    - Destroying or damaging property

    - Refusing to follow staff instructions

    - Any behavior that puts staff or residents at risk

    If I am terminated, I agree to leave the property immediatley upo staff request.

    I understand that failure to comply with removal may result in law enforcement being contacted.

    I understand there are no refunds if I am teminated for rule violations.

     

    By signing below, I acknowledge that I have read, understand, and agree to this immediate Termination Policy.

     

     

  • Termination Policy

  • I understand and agree to the following termination policy for IAMSENT Transtional Housing: 

    - I understand that continued participating in this program depends on following all rules and expectations 

    - Minor violations may result in verbal warnings or temporary removal (24-48 hour cooling-off periods). 

    - Serious violations, unsafe behavior, threats, drugs, or violence may result in instant termination (per Immediate Termination Policy). 

    - If terminated, I understand I must leave the property immidediately upon request 

    - I acknowledge that violating rules repeatedly or refusing to cooperate with staff may result in permanent removal from the IAMSENT program 

    By signing below, I acknowledge that I fully understand and agree to the Terms of Termination.  

     

  • Non-Discrimination Policy

  • IAMSENT Transitional Housing is committed to providing a safe, respectful, and inclusive environment for all participants.

    IAMSENT does not discriminate on the basis of race, color, religion, national origin, ancestry, citizenship, age, disability, medical condition, marital status, sex, gender, gender identity, gender expression, sexual orientation, veteran status, or any other status protected by applicable law.

    All participants are entitled to equal access to housing opportunities, program services, meals, common areas, and supportive services offered by IAMSENT.

    Harassment, intimidation, hate speech, discrimination, or retaliation toward any participant, staff member, volunteer, or visitor will not be tolerated and may result in disciplinary action or program discharge.

    IAMSENT is committed to maintaining a community where every participant is treated with dignity, respect, and fairness.

  • Reasonable Accommodation Policy

  • IAMSENT Transitional Housing is committed to providing reasonable accommodations to qualified individuals with disabilities and medical conditions when necessary to ensure equal access to program participation.

    Participants may request accommodations verbally or in writing at any time.

    Examples of accommodations may include:

    • Mobility-related accommodations

    • Medical-related accommodations

    • Communication assistance

    • Schedule modifications when appropriate

    • Other reasonable accommodations necessary for participation

    All requests will be reviewed on an individual basis.

    IAMSENT will engage in a good-faith interactive process to determine whether a reasonable accommodation can be provided without creating an undue burden, safety concern, or fundamental alteration of program operations.

    Participants will not be retaliated against for requesting an accommodation.

  • Grievance Procedure

  • IAMSENT Transitional Housing is committed to providing participants with a fair process to express concerns, complaints, or grievances.

    If a participant has a concern regarding housing conditions, staff conduct, program decisions, or treatment within the program, the participant may:

    Step 1:
    Report the concern to IAMSENT staff verbally or in writing.

    Step 2:
    Management will review the concern and may schedule a meeting with the participant to gather additional information.

    Step 3:
    A response will be provided within a reasonable period of time.

    Step 4:
    If the participant is dissatisfied with the response, they may request a secondary review by program management.

    Participants will not be retaliated against for submitting a good-faith complaint or grievance.

    All grievances will be handled respectfully and confidentially to the extent possible.

  • INTAKE COMPLETION CHECKLIST (STAFF USE ONLY)

  • - Intake Form Completed 

    - ID Verified 

    - Housing Agreement Signed 

    - Rules & Conduct Agreement Signed 

    - No-Refund Policy Signed 

    - Program Participation Agreement Signed  

    - Chore Agreement Signed 

    - Non-Discrimination Policy Signed 

    - Media Consent Signed 

    - Grievance Policy Signed 

    - Reasonable Accomodation Policy Signed 

    - Termination Policy 

    - Immediate Termination Policy Signed 

    - Orientation Completed 

    - Room Assigned 

  • Should be Empty: