Housing Pool Check-in

Housing Pool Check-In Form

Check-in form for the Whatcom County Coordinated Entry System. To be used monthly to stay current in the system.

Whatcom County Housing Pool Check-In Form

Please submit this form once a month to stay current in the housing pool for the Whatcom County Coordinated Entry Housing System.

Are you checking in for a single person or a household of people?

Single Person

Household

How many people are in your household?

Name(Required)

First Last

Your Date of Birth

Phone

This phone is safe to:

Call

Leave a voicemail on

Send text messages to

Mailing Address

Street Address Address Line 2 City State ZIP Code

Where did you stay last night? Please be specific.(Required)

How long you have been staying at that location?(Required)

Monthly Income(Required)

Sources of Income(Required)

Please list all of your current sources of income (for example: wages, TANF, SSI, ABD, etc)

Recent changes to your household.(Required)

Please describe any recent changes to your household. For example: custody status, number of household members, new case managers. If there have been no changes, enter "none" or "no changes".

This field is for validation purposes and should be left unchanged.