Chittenden Transitional Housing Point in Time Count
Complete this form on:
Wednesday, January 27, 2021 (6PM – 6AM “Where are you currently staying?”)
OR Thursday, January 28, 2021 (6AM – 6PM “Where did you stay last night?”).

COMPLETE ALL 5 sections.

Please read questions carefully.  Note that you will have the opportunity to edit your responses at the end of the survey, if necessary.
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Project Name on HIC *
Complete this survey ONLY for clients staying in your transitional housing projects on the night of the PIT count. If you encounter unsheltered clients on the night of the PIT count, please administer the unsheltered survey.
Staff/Volunteer Name (First & Last) *
Staff/Volunteer Phone & Email
SURVEYOR: Is this the first time you (or your team) are filling out a survey with this individual/family during this Point in Time? *
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