HMIS
Please email the below HMIS forms to: HMIS@stancounty.com
HMIS Report Data Request Form
HMIS Report Data Request FormHMIS Project & Grant Set Up Forms
HMIS Project Set Up FormHMIS Grant Set Up Form
HMIS Bed & Unit Inventory Update Form
HMIS User Access Request Form
New User Request FormUser Policy Responsibility Statement
HMIS Client Consent & ROI
Client Informed Consent & Release of Information (English)Client Informed Consent & Release of Information (Spanish)
Annual or Update Forms
Outreach Universal Program Update FormPATH Program Update Form
Universal Program Update Form
Assessments
Self-Sufficiency MatrixVI-SPDAT for Families
VI-SPDAT for Single Adults
VI-SPDAT Transition Age Youth (ages 13-24)
Exit Forms
Child Program Exit Form- All ProgramsPATH Program Exit Form
RHY Program Exit Form
RHY Outreach Exit Form
SSVF Program Exit Form
Universal Exit Form
Universal Outreach Exit Form
Intakes
Child Program Intake Form- All ProgramsCoC, ESG, Private Funded Intake Form For Persons Entering a Shelter
CoC, ESG, Private Funded Intake Form For Persons Entering Transitional Housing, Any Permanent Housing, Rapid Re-housing, or Homeless Prevention
Coordinated Entry Program Intake Form
PATH Program Intake Form
RHY Program Intake Form
RHY Outreach Program Intake Form
SSVF Program Intake Form
Universal Outreach Program Intake Form
VA GPD Program Intake Form
Outreach Contact Forms
Universal Outreach Contact FormComing Soon.
Coming Soon.
HMIS Participating Agencies – Updated July 30, 2020
HMIS Participating Agencies [PDF]- (BHRS) Stanislaus County Behavioral Health & Recovery Services
- (CCD) Catholic Charities Diocese of Stockton
- (CHS) Center for Human Services
- (CHSS) Community Housing and Shelter Services
- (CICV) Community Impact Central Valley
- City of Modesto
- (CSA) Community Services Agency
- (FP) Family Promise
- (HOST) Host House/Cambridge Academies
- (HA) Stanislaus Regional Housing Authority
- (MGM) Modesto Gospel Mission
- Outreach and Engagement Center
- Salvation Army
- (STANCO) Stanislaus County Affordable Housing Corp
- Stanislaus County CARE
- Stanislaus County Department of Planning
- Turning Point Community Programs
- United Samaritans Foundation
- We Care Program Turlock
- West Care San Joaquin Valley Veterans
For HMIS questions or concerns please email: HMIS@stancounty.com
Helpful Numbers
- Lynnell Fuller, HMIS Administrator
- Desk: (209) 558-3676
- Patty Estrada, HMIS Specialist
- Desk: (209) 558-2381
Copyright © Stanislaus County, California 2018
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