Shelter Access Pre-Screening Form Transition Projects shelters serve adults 18+ who are currently experiencing homelessness in Multnomah County.Completing this form does not guarantee you a shelter bed now or in the future, and we cannot make same-day placements.Our Shelter Access team will respond to all submissions within two business days to gather more information.If you are requesting a couples bed, both adults must submit this form. Be sure to include who you are requesting with in the final response box. Name * First Name Last Name Email * Phone Number (###) ### #### Gender * Female Male A gender other than singularly male or female (e.g., non-binary, genderfluid, agender, culturally specific gender) Transgender Questioning I'd rather not say Race * American Indian, Alaska Native, or Indigenous Asian or Asian American Black, African American, or African Native Hawaiin or Pacific Islander White Other I'd rather not say Ethnicity * Non-Hispanic/Non-Latin(a)(o)(x) Hispanic/Non-Latin(a)(o)(x) I'd rather not say Date of Birth * MM DD YYYY Do you currently reside in Oregon? * Yes No What city or town do you currently reside in? * Do you consider yourself to be disabled? * Yes No I'd rather not say Do you use any mobility devices? * Yes No I'd rather not say If yes, what type of device do you use? Do you have any pets? * Yes No If yes, what type and how many? Are you a veteran? * Yes No I'd rather not say Can you access a top bunk safely? * Yes No I'm not sure Do you prefer an abstinence-based environment (including from alcohol and marijuana) or a low-barrier environment? * Abstinence-based environment Low-barrier environment No preference Not sure Is there any other information you think we should know? Thank you for your interest! Someone from our team will be in touch soon.
