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
Unsheltered Homeless Count Form
USE FOR: recording each county's total unsheltered homeless count
| Unsheltered Homeless Form |
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 |
PDF form |