Roy's Desert Resource Center Intake

  Applicant information:

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Name:

 

 

 

     

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Date of Birth:

 

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Question - Required - Family status of applicant:



 

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Does the applicant(s) receive any of the following:

   


   


   


   


   


   


   


   


 

Please check one of the following statements that applies to the family's current homeless status:

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