North Carolina Coalition to End Homelessness

2017 PIT Count Forms

For non-Balance of State CoCs


The 2017 North Carolina Point-in-Time Count will be held the night of Wednesday, January 25, 2017. Please use the forms below to record and report data from the count.

Please check with your local PIT coordinator or CoC lead to determine which forms you should use.

Sheltered Homeless Count Form

USE FOR: emergency shelters (including domestic violence shelters), seasonal shelters, transitional housing programs 

HMIS Agencies
Word form (fill out on computer)
PDF form (fill out by hand)
Non-HMIS Agencies
Word form (fill out on computer)
PDF form (fill out by hand)
  

Rapid Re-Housing Count Form

USE FOR: rapid re-housing programs

HMIS Agencies  
Word form (fill out on computer)
PDF form (fill out by hand)
Non-HMIS Agencies
Word form (fill out on computer)
PDF form (fill out by hand)



Permanent Supportive Housing Count Form

USE FOR: permanent supportive housing programs

HMIS Agencies 
Word form (fill out on computer)
PDF form (fill out by hand)
Non-HMIS Agencies
Word form (fill out on computer)
PDF form (fill out by hand)



Unsheltered Homeless Count Form

USE FOR: recording each county's total unsheltered homeless count

Unsheltered Homeless Form

Word form (fill out on computer)
PDF form (fill out by hand)



Point-in-Time Count Survey & Youth Addendum

USE FOR: interviewing homeless persons during the count to collect needed information 
  • You may edit the Word version of the survey to add extra questions your community may wish to ask.
  • The Youth Addendum is an optional set of extra questions to gather additional information about homeless youth (people under age 25). 
Point-in-Time Count Survey
Word document (editable)

Optional Youth Addendum
(additional questions for youth under age 25)

PDF form
 

Imminently Homeless/At-Risk of Homelessness Form

USE FOR: optional counts of people who are imminently literally homeless or at risk of homelessness.

Imminently Homeless/At-Risk of Homelessness Form
Word form (fill out on computer)
PDF form (fill out by hand)
 
Tags: practice