ECTLC Pre-Screen

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ECTLC Pre-Screen

Please complete this information for the main person seeking housing / program.

Name of Person needing housing

Phone Number

Is it safe to text or leave a message?

Yes

Clear selection

Which program are you interested in?

Individual Male

Individual Female

Family [parent(s) with at least one child]

Harness House - Men's Sober Living Home

Family

Clear selection

Are you experiencing homelessness?

Yes

Option 3

Other:

Are you homeless in El Cajon?
(If no, type in where you are located.) *

Yes

Option 2

Other:

Date of Birth

Names and ages of children who live with you.
more than 50% of the time.

Email Address

Please list all prescription medications
or other substances (including alcohol)
currently using or have recently used.

Other important information?

Next Steps

Thank you for completing our pre-screen document. We will be running a background check and contacting the identified person within 24 hours. To prepare, the person needing housing should have their ID available and 30 days supply of any approved medication. Call with any urgent questions: 619-442-0457. Call 211 for more housing resources and 911 for any emergencies.

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This form was created inside of East County Transitional Living Center. Report Abuse

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