Intake

Client intake data sheet — tell us what you need.

This form helps our team understand who you are and what kind of support you are looking for, so we can connect you with the right program or service.

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Before you start

What this form is for

The intake data sheet is the first step when you come to Compassion for Lives for help. It takes a few minutes, and everything you share stays with our team.

Your information

Basic contact details and background so we can reach you and understand your situation.

What you need

The services you are interested in — housing, career readiness, GED, SNAP/Medicaid, Social Security, or substance abuse support.

What happens next

Our team reviews your intake and follows up with you about the right program or next step.

Intake form

Complete the intake data sheet

Fill in what you can. If you are not sure about an answer, leave it blank or choose “Not Sure” where offered — we can sort it out together.

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Do you have a driver's license?
If not, do you have a state-issued ID?
Are you registered to vote?
Have you ever been convicted of a felony?
Skills used on past jobs — check all that apply
Services interested in — select all that apply