Cuyamaca Cares Housing Intake Form

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By completing this form you are allowing Cuyamaca Cares to connect you to services that are right for you and your individual circumstances. Please complete this form to the best of your ability and a Cuyamaca Cares staff member will contact you. Due to the high volume of students requesting assistance, please allow at least one week for a response. We appreciate your patience.

This housing intake form is for those who are currently experiencing homelessness or are at a high-risk of homelessness (i.e. have been given an eviction notice or have been informed that you will be receiving one).

Email *

First Name *

Last Name *

Student ID Number *

Age *

Household size, including yourself *

Number of children under 18 (if none, please enter N/A) *

Are you currently experiencing homelessness? *

Yes

If no, have you recently been served an eviction notice? *

Yes

N/A

Please describe your current living situation (i.e. with friend or family member, in car, in shelter, etc.) *

Current city (does not have to be an address, just the city you currently reside in) *

Are you employed? *

Yes

Monthly income (your answer will not impact Cuyamaca Cares' ability to assist you) *

Are you interested in employment assistance? *

Yes

Are you currently receiving CalFresh/EBT? *

Yes

Are you planning on transferring to a university after Cuyamaca? *

Yes

If yes, where are you planning to transfer? (If you are not planning on transferring, please enter N/A) *

Please describe what housing services you are hoping to obtain *

A copy of your responses will be emailed to the address you provided.

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