VI-SPDAT REQUEST FORM

Please note: Family Promise does not have its own housing programs. During your appointment, you will complete the VI-SPDAT and connected to resources that you request.

To request an appointment to meet with a Family Navigator for to complete the VI-SPDAT, please complete the form below.

You must meet one of the following definitions of “family” Please select which applies to you:

I have at least one child under 18 in my physical custody at least 50% of the timeI am pregnant (or my partner is pregnant) in the third trimesterI have an adult child over 18 with disabilities, who relies on me for daily livingI have a child that is 18 years old or older and still in high school

What county do you currently reside in?

You have to be in the State of Colorado to receive services from us.

Full Name & Date (Ex: John Smith 1.2.21)

First Name

Last Name

Phone

Preferred contact method

Gender Identity

Other Gender Identity

Demographic

Other Demographic

Birthdate

Are you currently Pregnant?

Due Date

Where did you stay last night ?

How much longer can you stay at this location?

Why is this place no longer an option?

Is this your first time experiencing homelessness?

How many episodes of homelessness have you experienced in your life?

How long have you been "literally" experiencing homelessness (staying on the streets, outside, shelter, or other place not meant for human habitation)?

Where else has your family stayed during this time? ( Hold command or control and click to select all that apply.

Are you fleeing from Domestic Violence?

Do you know if you have taken the VI-SPDAT before?

The VI-SPDAT (Vulnerability Index - Service Prioritization Decision Assistance Tool) is a survey administered both to individuals and families to determine risk and prioritization when providing assistance.

Are you interested in completing the VI-SPDAT? (In order to qualify, you need to be literally homeless (staying outside, in your car, a shelter, or motel paid for by agency)

Anything else you would like to add about your housing situation that would help us?

What do you use for Transportation?

Would you be interested in sharing your story?

If you'd like to share your story now, please click the link and fill out our form. Click Here

By filling out this form, you are being added to our client contact list so we can contact you in the future. You can contact us to be removed at any time by e-mailing us at hello@fpgd.org.

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Client Intake Record Type ID

Account Record Type ID

Client

Submission Type

Intake Status

Service Client Seeks

Account Source

Assisted program

Interested in Housing Navigation

Contact Information