HMIS Project Setup Request V2
Please fill out this form for new HMIS projects
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Email *
Name of your Organization *
Where will the project operate?
Is your organization new to HMIS or are you adding a new project to existing projects in HMIS? *
Please provide a short description of your agency:
If known, when did your organization join the BOS (Balance of State) Continuum of Care? (estimates are ok)
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Mailing Address
Please provide street address or P.O. Box #
Mailing Address ZIP Code
Physical address
If possible, please provide the physical address where housing, shelter or services will be located. If "scattered sites", please enter all cities where housing, shelter or services will be located.
Physical Address ZIP Code
Which is this your primary address?
Clear selection
Primary Telephone Number
Primary Contact Person Name
Primary Contact Person Title
Primary Contact Person Email
Primary Contact Person Phone Number
Your Organization's Website Address
Your Organization's Hours of Operation
Intake/Application Process
Languages
Handicap Access
Clear selection
Name of Project
Description of Project
Please provide a short abstract of your project
Physical Address
Please provide street address
Zip Code
Please provide ZIP code that reflects the location of the project’s principal site or, for multiple site projects, the location in which the majority of the project’s clients are housed. Tenant-based scattered site projects and non-housing projects can use the administrative address.
Eligibility Requirements
Handicap Access
Clear selection
Operating Start Date
When did the Project first open?  Operating start date should reflect the first day on which a project provided (or will provide) services and/or housing. This is typically different from the date your Organization started.  For projects that began operating prior to October 1, 2012, the start date may be estimated if it is not known.
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Project Type *
Housing Type
Target Population *
At least 75% of persons served by this project meet the population definition
Target Population A *
Household Type *
Number of Beds
Number of Units
If you are serving multiple member households, please record the number of units for households in your project.  If you are serving individuals, number of units equals the number of beds above.  Example: PSH has 4 three bedroom apartments with a capacity of 4 families and a total of 15 beds.  (Number of Beds = 15) (Number of Units = 4)  
When did the units and beds come online?
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Chronic Homeless Bed Inventory (PSH Only)
Record Total Number Below
Veteran Beds Inventory
Record Total Number Below
Youth Beds Inventory
Record Total Number Below
Is this project receiving federal funding? *
Grant Identifier Number
A grant identifier is to be assigned to each federal program being used for funding for the project. The grant identifier may be the grant number or any other identification system utilized by the CoC.
Grant Start Date
Refer to your project application
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Grant End Date
Refer to your project application
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YYYY
Does this project receive funding from  additional federal funding sources? *
Refer to your project application for this information
Grant Identifier Number
A grant identifier is to be assigned to each federal program being used for funding for the project. The grant identifier may be the grant number or any other identification system utilized by the CoC.
Grant Start Date
Refer to your project application
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Grant End Date
Refer to your project application
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Does this project receive funding from  additional federal funding sources? *
If Yes, please notify your HMIS System Administrator
A copy of your responses will be emailed to the address you provided.
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