Coordinated Housing Access Intake 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)

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

Alternative Contact Information (optional)

What's the best way to reach you?


I need...
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