Coordinated Housing Access Inquiry Form

This is not an application for Coordinated Housing Access rental assistance. This form is used to help us gain a better understanding of your current housing situation.

Are you experiencing a housing crisis in Clackamas County? (Are you homeless or at risk of homelessness)

Yes

Unfortunately we are only able to serve people in Clackamas County. If your answer is no, please contact 211 and ask for housing services in your area.

Head of Household Information

Name

Phone number

What is your preferred language?

What's the best way to reach you?

Phone

Text message

I need...

Help paying rent

Help finding housing

An accommodation to complete the assessment (normally completed over the phone)

Other…

Please describe what type of housing issue you're trying to address.

Please describe accommodation needed:

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Coordinated Housing Access Inquiry Form

Head of Household Information

SHORTCUTS

ELECTED OFFICIALS

Can’t find what you're looking for?

Coordinated Housing Access Inquiry Form

Head of Household Information

Alternative Contact Information (optional)

Assistance

SHORTCUTS

ELECTED OFFICIALS