Coordinated Entry — housing assessment

The HUD-required Coordinated Entry intake for the Antelope Valley's Continuum of Care

Audience · Adults seeking housing assistance through the Los Angeles County CoC (CA-600)Time · ~15 min

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About you

Full name

Preferred name

Date of birth

Phone (if you have one)

Email (if you have one)

Languages you speak

Helps us match you with a navigator who speaks your language.

Where you are right now

Tonight you will sleep…

When did you most recently lose stable housing?

How many months in the last 4 years have you been homeless?

Best estimate. This affects whether you qualify for chronic-homeless priority.

Household composition

Which best describes your household?

This routes you to the right RCS queue.

Are you or anyone in your household pregnant?

Your situation

These questions help match you with the right level of support. You can skip anything you're not ready to answer.

Do you have a disability, mental health condition, or chronic illness?

If yes, do you have documentation (doctor's letter, SSDI, VA disability)?

Chronic-homeless designation requires documented disability — it unlocks higher-priority placements.

Have you served in the U.S. armed forces?

Fleeing domestic violence?

If you are fleeing domestic violence, please do NOT submit this packet through HMIS — entering coordinated-entry data can expose your location. Call the National DV Hotline at 1-800-799-7233 (24/7), which can connect you to a local domestic-violence agency. They can help you apply through a separate, confidential VAWA-compliant system. We do not ask about or store this here.

Anything you want the navigator to know before you meet?

Your answers save automatically as you type.