• Summer 2026 Point in Time Count Form

    For Berkshire, Franklin, and Hampshire Counties

  • This is a Point in Time Count survey for the Three County Continuum of Care. This form should be used to survey persons who may not have had access to housing on the night of Sunday July 26th, 2026.

    This should only be used for people who were in Berkshire, Franklin, or Hampshire Counties on the night of Sunday July 26th, 2026. 

    Surveys can be completed between 10:00 PM Sunday July 26th through 11:59 PM Sunday August 2nd. 

    Please answer as many questions as you comfortably can. Many of the questions are optional to respond to. This data helps inform our communities on how many people are experiencing homelessness and how much of a need there is for housing for special populations.

    Please contact Emma Coles, DV/EMERG Coordinator at ecoles@communityaction.us for questions about this survey.

  • Location of Interview (where you are completing this survey)
  • Which town did you stay in on Sunday July 26th? (NOTE: If outside of Berkshire, Franklin, or Hampshire Counties, STOP here.)*

  • Where did you sleep on Sunday night, July 26th, 2026?*

  • Permanent housing - if you were in your own rental or home on Sunday July 26th, 2026, we cannot collect a survey response for you. Please double check the "Other situation" option to see if any situations listed in the follow up question apply. 

    If they do not, please stop here and do not submit the survey. Thank you for your participation!

  • Unsheltered Situations - Which of the following best describes where you were Sunday night, July 26th?*

  • Other Situations - Which of the following best describes where you were Sunday night, January 25th?*
  • How many months have you experienced homelessness in total during the last 3 years (Since July 2023)? Please only include time in a shelter or unsheltered situation. Do not include any months of other types of housing instability like couch surfing.*
  • Were you fleeing domestic violence when you became homeless this time?*
  • Have you served in the US Armed Forces on active military duty?*
  • What is your age?*
  • How do you describe your gender identity? Check any that apply.*
  • What is your race and ethnicity? Check any that apply.*

  • These next few questions help our community determine how much of a need there is for housing for special needs or disabiliites.

    Please remember that you may choose "Prefer not to answer" to any answers you may not want to disclose.

  • Have mental health needs interfered with your daily life, now or in the past? (Disability due to mental, emotional, or behavioral health condition)*
  • Have drug or alcohol use interfered with your daily life, now or in the past? (Disability due to substance or alcohol use disorder)*
  • Are you HIV positive?*
  • Do you have any type of disability that interferes with your daily life? This could include disabilities from physical, chronic medical, developmental, mental, behavioral, or emotional health needs*

  • Help us to not double-count you!

    We collect the following information only to make sure we don't count you twice, in case you are surveyed more than one time.

    We ask for the following infformation:

    • First letter of your first name
    • First 3 letters of your last name
    • Month you were born
    • Year you were born

  • Special Instructions for clients fleeing DV:

    Please use a coded ID based on "Anonymous."  For example, "Anon Adult 1," "Anon Adult 2," "Anon Adult 3," "Anon Child 1," etc.  Enter this information into the first field below.  Skip the next 2 fields.  

     

     

  • What month and year were you born?Month:       Year:   *      Example: Someone born December 1975 would be 12 -1975
  • Household Status
  • Should be Empty: