DEMO VT Unsheltered Point in Time Count
DO NOT ENTER REAL CLIENT DATA IN THIS FORM.
Practice use only.

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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Agency Name
Agency Town
Staff/Volunteer Name (First & Last) *
Staff/Volunteer Contact *
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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