Form Testing HRIF HRIF Name of Organization * Position: (Executive Directore/CEO only) Name * Name First First Last Last Phone * Email * Program or service to be included in CA Case management Transitional beds Units/spaces Subsidies Other (provide details below) Total number (e.g. case managers, beds, units/spaces, subsidies, etc.) allocated to the inventory of CA in Simcoe County Acuity level (please refer to VI-SPDAT scoring guidelines): Moderate Severe Specific criteria (if any) Additional information (if any) CAPTCHA If you are human, leave this field blank. Submit Δ HRAF HRAF Agency Name * Program name Type of housing resource Units/Spaces Subsidies - rent supplements Subsidies - subsidized units Case Management/Housing Help (Housing First) Case Management/Housing Help (General) Transitional Housing Name * Name First First Last Last Phone * Email * Type(s) of households served Adults Youth Family Acuity Served: (VI-SPDAT Range) Moderate Intensive Ages Served: 0-24 24-54 55+ Gender Identity Served: Male Female Transgender X Accessibility of Units No Stairs/Has elevator Wheelchair accessible Main floor access Identification required Yes No Financial documentation required Yes No Financial/Income Contribution Expected from Clients (Rent/Fees): Pets Allowed (Not including Service Companions): Yes No Specific Service Conditions (Sobriety, Medication Compliance, Services): Additional Eligibility Requirements/Information: reCAPTCHA If you are human, leave this field blank. Submit Δ
