CES Intake Form

Please complete as much information as possible and a Coordinated Entry Intake Specialist will return the persons call within 3-5 business days. 

Please inform callers that the Specialist will be continuing the conversation to better assist the caller to resolve their homelessness.

A call DOES NOT guarantee services.

Please refer to the intake call tree, all callers must be either: literally homeless or Veterans at risk of being homeless.

Person’s Living Situation:

Population Type:

Agency Completing Request Form:

Internal Notes:

*** Please send all VA referrals to HSN Fax # 407-893-5299 with attention to Veteran Programs.