BRISTOL COUNTY CONTINUUM OF CARE

The CoC pursues a comprehensive response to homelessness using a “Continuum of Care” methodology through a community-based network. The BCCC is a membership-driven collective of over 60 organizations, agencies and individuals committed to working together in addressing all variants of homelessness particularly those experiencing chronic homelessness and those unsheltered/unhoused.

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BRISTOL COUNTY CONTINUUM OF CARE (BCCC)

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Coordinated Housing Assessment Tool

Experiencing homelessness now? Complete our CHAT Tool below. Please provide as much information as possible.

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This Coordinated Housing Assessment Tool is only available to individuals and families who are either unsheltered and in New Bedford or in an emergency shelter in the city. Fully completed forms that are submitted below, will be automatically sent to our Coordinated Entry Team who will reach out to you, directly.

Are you currently living unsheltered on the street or in an emergency shelter in New Bedford? *

Yes
No

Not Eligible

Although you are not eligble for services offered with our emergency Chat Tool, we encourage you to explore our Street Sheet for other resources.

Head of Household (Full Name) *

Social Security Number (Optional)

Date of Birth *

Gender Identity *

Male
Female
Transgender
Nonbinary
Prefer not to answer

Household Description *

Single
Family
Couple

Email *

Phone Number *

Address *

How is contact preferred? *

Phone
Email
Mail

Military Service? *

Yes
No

BASELINE CONVERSATION

Where did you sleep last night? *

Is that a safe environment for you? *

Yes
No

Additional Info

Are you fleeing a domestic violence situation? *

Yes
No

Additional Info

How long have you been sleeping in this location/situation? *

Additional (Optional) Phone

Where were you prior to that? *

What do you need? *

Where would you like to be? *

HOUSEHOLD COMPOSITION

Name *

Date of Birth *

Head of Household *

Yes

Gender *

Male
Female
Transgender
Nonbinary
Prefer not to answer

Name

Date of Birth

Relationship

Gender

Male
Female
Transgender
Nonbinary
Prefer not to answer

Name

Date of Birth

Relationship

Gender

Male
Female
Transgender
Nonbinary
Prefer not to answer

Name

Date of Birth

Relationship

Gender

Male
Female
Transgender
Nonbinary
Prefer not to answer

Name

Date of Birth

Relationship

Gender

Male
Female
Transgender
Nonbinary
Prefer not to answer

RACE | ETHNICITY of HEAD OF HOUSEHOLD

Please indicate Race | Ethnicity for Head of Household *

American Indian, Alaska Native or Indigenous
Asian or Asian American
Black, African American or African
Hispanic/Latina/e/o
Middle Eastern or North African
Native Hawaiian or Paciﬁc Islander
White
I Don't Know
I Prefer Not to Answer

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Home
About Us
CoC Data Center
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Resources
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Contact