Project Information Form
This form has two uses:

One is for any Knoxville-Knox County agency that wants their agency or project information listed on the community-wide housing online directory www.knoxhousinghelp.com

This form can also be used by KnoxHMIS partner agencies to update or add new agency/program information. If you are a KnoxHMIS partner, please make sure you know your funding sources and any applicable grant numbers and their start and end dates before starting this form.

This form should take 15 minutes or less to complete per program.

 If you have questions about this form, please contact hmissupport@utk.edu. Thanks!
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Email *
Name of person submitting changes *
First and last name
KnoxHMIS Partner Agency Name *
The main, DBA name of service provider, e.g., KARM, VMC, CAC, etc.
Project Name *
Contact Phone (for public website knoxhousinghelp.com) *
Format is ###-###-####
Fax Number (if none, mark N/A)
Format is ###-###-####
Contact Phone Extension Number, when applicable
When did/does this program begin? *
MM
/
DD
/
YYYY
Agency/Program Description *
Physical Address *
Mailing Address *
Primary Contact's Name *
Please list the lead staff, case manager, or primary referral contact here.
Primary Contact's Title *
Primary Contact's Email *
Please list all staff for whom this project should be their PRIMARY project in HMIS.
Please list all staff who should not have this project as their PRIMARY project, but should still have "EDA access" to it (i.e., be able to enter or change client data "as" this project, or view client records even if their data are restricted solely to this project)
Days and Hours of Operation *
Agency Website Address *
Eligibility Criteria for Services *
Please list what is required in order for a person to receive services from your agency or program (e.g. age limit, income limits, etc.)
Intake/Application Process *
Please list any documents that individuals will need at intake (e.g. valid identification, birth certificate, case management referral, etc.)
Program Limitations
Please describe any limitations you have for providing services (e.g. up to 90 days, two times in a year, ex-offenders, etc.)
Spoken Languages *
Does your agency require that a person have insurance in order to receive services? *
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