2011 Point-in-Time Count Forms

 The forms posted below are the final versions.
Please use these versions to collect and report your data.  Do not use the draft versions that were posted earlier, which read "SAMPLE".
 

Sheltered Count Form

Each emergency shelter, transitional housing program, and permanent supportive housing program in the state should fill out one of these forms.
  • Programs in the Balance of State CoC should turn the forms in to NCCEH.
  • Programs in all other CoCs should turn the forms in to their local PIT coordinator.
Sheltered Count Form
 

Unsheltered (Street) Count Form

Communities conducting street counts or services-based counts of unsheltered homeless persons should use this form to report their data.
  • Programs in the Balance of State CoC should turn the forms in to NCCEH.
  • Programs in all other CoCs should turn the forms in to their local PIT coordinator.
Unsheltered Count Form
 
 

NC Homeless Demographic and Needs Survey

Use this survey while interviewing homeless persons during the count to collect needed information.
  • These forms do not need to be turned in to NCCEH.  Check with your local PIT coordinator to see if forms are being collected locally.
NC Homeless Demographic and Needs Survey
 
 

State Reporting Form

This form is for CoC leadership to report the CoC's total count to the State of North Carolina. 
  • Each CoC in North Carolina must submit one of these forms to NCCEH.
State Reporting Form
 
 

Housed and At-Risk of Homelessness Form

This form is for communities to count numbers of people who are at-risk of homelessness.
  • This form is optional.  Check with your local PIT coordinator to see if forms are being collected locally.
Housed and At-Risk Form
 
 

2011 Point in Time Count Training

NCCEH held a PIT training on January 12, 2011. view PowerPoint presentation