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TCHC

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Step 1 of 6 – Contact Information

16%
Online CES
Assessment (Below)CES Assess Point
843-492-2600Veteran Housing Services
843-492-2594Other Services (SC 211)
866-892-9211

Coordinated Entry System Assessment

Service Area

Total Care for the Homeless Coalition (TCHC) is a Continuum of Care with a service area that includes the South Carolina counties of Chesterfield, Clarendon, Darlington, Dillon, Florence, Georgetown, Horry, Kershaw, Lee, Marion, Marlboro, Sumter, and Williamsburg.

Eastern Carolina Housing Organization (ECHO) is also able to serve qualifying Veterans in the North Carolina counties of Columbus, Robeson, and Scotland.

Getting Help Through Coordinated Entry System

Agencies within the TCHC network are here to support eligible households referred through TCHC’s Coordinated Entry System (CES). CES is a process that assesses and prioritizes people who are homeless or at risk of becoming homeless, connecting them with available housing programs.

Due to limited resources, CES focuses on helping the most vulnerable individuals and families first. Please note that completing this form is only the first step in being considered for help through CES, and it doesn’t guarantee services.

While we assess your situation, we encourage you to continue seeking assistance through other community resources. You can reach 211, a statewide resource guide, by dialing 211 or visiting 211.org. For more information about TCHC and the Coordinated Entry System, visit our About page by clicking here.

You have indicated that you are not within our qualifying service area however there are still resources available for you. 211 serves as a resource listing and we encourage you to dial 211 from a mobile phone or visit:

  • SC 211
  • NC 211
  • National 211 Registry
Please select the situation that best describes your current experience.

Please call the TCHC Access Point between 9:00AM and 4:00PM at 843-492-2600 to complete a telephone assessment.

I am currently unhoused.

Last night I slept, or will be sleeping tonight in one of these locations:

  • Outside
  • In an abandoned building, vehicle, or another place not meant for people to sleep
  • In an emergency shelter
  • In a hotel or motel paid for by a third-party service provider
I am fleeing a domestic violence situation

I am currently fleeing or attempting to flee a domestic violence situation.

I am being evicted.

I have received an eviction notice from my landlord and do not have the resources needed to stay in my home or locate other housing.

A copy of your eviction notice, and proof of income if applicable, must be submitted with this completed assessment to process your information. Submissions without these documents will not be accepted.

Consent for Data Usage*

Privacy Statement


Summary Overview
This organization provides services for individuals and families at risk of or experiencing homelessness. This organization participates in the South Carolina Homeless Management Information System (SC HMIS) and/or the four Continuums of Care’s Coordinated Entry System (CES).
The SC HMIS is used to collect basic information about clients receiving services from this organization. This requirement was enacted to get a more accurate count of individuals and families experiencing homelessness, and to identify the need for different services.
The SC CoC’s CES is used to connect individuals and families at risk of or experiencing homelessness to the services they need.
This organization only collects information that is considered appropriate and necessary. The collection and
use of all personal information are guided by strict standards of privacy and security.
This organization may use or disclose information from the SC HMIS and / or the TCHC CoC’s CES under the following circumstances:
• To provide or coordinate services for an individual or household;
• For functions related to payment or reimbursement for services;
• To carry out administrative functions;
• When required by law;
• For research and / or evaluation; or
• For creating deidentified data.

Uses, Risks, and Protections
• Information you provide to this organization will be entered into the HMIS and shared with partner organizations unless you opt-out.
• You will receive the same services, whether you allow your personal information to be entered in the HMIS and shared with partner organizations or not.
• Your personal information that is in the HMIS will not be shared with any other people or organizations outside of HMIS unless you say it can be.
• Your personal information that is in the HMIS will not be shared with any other government organizations except as required by law.
• Personally Identifying Information (PII), such as names, birthdays, and social security numbers, will be available to partner organizations in the HMIS for seven years.
• Although careful measures are taken to protect the personal information entered in the HMIS, it may be possible that a person could access your information and use the information to locate you, commit identity theft, or learn about sensitive personal information entered in the HMIS.
• Your data is protected by legal agreements signed by Users of the HMIS and by electronic encryption of your personal information.

Your Rights and Choices
• Information you provide to this organization will be entered into the HMIS and shared with partner organizations unless you opt-out.
• You will receive the same services, whether you allow your personal information to be entered in the HMIS and shared with partner organizations or not.
• Your personal information that is in the HMIS will not be shared with any other people or organizations outside of HMIS unless you say it can be.
• Your personal information that is in the HMIS will not be shared with any other government organizations except as required by law.
• Personally Identifying Information (PII), such as names, birthdays, and social security numbers, will be available to partner organizations in the HMIS for seven years.
• Although careful measures are taken to protect the personal information entered in the HMIS, it may be possible that a person could access your information and use the information to locate you, commit identity theft, or learn about sensitive personal information entered in the HMIS.
• Your data is protected by legal agreements signed by Users of the HMIS and by electronic encryption of your personal information.

Contact Information

No Phone
If you do not have an email address you may visit gmail.com or outlook.com to get a free email address.
Alternate Contact Name*

Confirm Information

Current County: Update information

Veteran Status: Update information

Current Living Situation: Update information

Email Address: Email Required Update information

Accuracy Verification*

Please complete all fields to continue.

Demographic Information

Your Name (Head of household)*
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MM slash DD slash YYYY
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Select all that apply.
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Select any long-term disabling conditions that you identify as having*
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Household Information

Please enter the total number of persons experiencing a housing crisis.
Please enter a number from 1 to 10.
Name Relationship to Head of Household Actions
   
There are no Household Members.

Maximum number of household members reached.

Please add all other members of your household that are currently experiencing a housing crisis. If the pop-up for adding a household member does not appear be sure your browser is not blocking pop-ups and try refreshing the page.
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You have entered that there are household members. All household members must be included to process your Coordinated Entry Assessment. If you are having trouble completing this form, please contact 843-213-1798 to complete a telephone assessment.
MM slash DD slash YYYY
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Select any non-cash benefits received:

Please complete all fields to continue.

Current Situation

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MM slash DD slash YYYY
Do you have an eviction notice from the landlord or magistrate?*
MM slash DD slash YYYY
Approximate date this most recent episode of homelessness started*
A break in homeless episodes includes:
7 days or more in a rental unit, staying with family or friends, hotel or motel paid for by self
-or-
90 days or more in an institution such as hospital, jail, detox, or inpatient treatment.
Select which of the following items you currently have:
Current Address*

Homeless Prevention Notice

We cannot process your application if your eviction is more than 21 days away. Please come back to complete your application immediately after you are within this 21 day window.

All applicants for Homeless Prevention assistance must meet income and other eligibility requirements. You will be asked to provide documentation including verification of household income and either a Magistrate’s Court Order of Eviction or a letter from the landlord stating the applicant is behind on rent and will be evicted within 21 days.

ECHO may not be able to serve everyone that needs assistance. You are encouraged to continue attempting to resolve your housing crisis through other community resources. 211 serves as a state resource guide and can be reached by dialing 211 from your mobile phone or visiting the 211.org website.

Please complete all fields to continue.

Additional Information

Please enter a number greater than or equal to 0.
Include current income total for all adult household members. Be sure to include any current regular earned income (if you are currently employed), unemployment insurance, SSI, SSDI, VA Disability Compensation, private disability insurance, Worker’s Compensation, TANF, retirement, pension, child support, alimony, or any other regular income source that you are currently receiving.
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HP Scoring

HP Scoring Information

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Additional Information

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Acuity Tool

Acuity Measures
Do you have now, have you ever had, or has a healthcare provider ever told you that you have any of the following medical conditions?*
Check all that apply.
Please select all of the following which are true.*
Check all that apply.

Please complete all fields to continue.

Documentation

We will need each of the following documents submitted. If you do not have them at this time, please begin attempting to get replacement copies.

  • Government Issued ID
  • Social Security card
  • Proof of income or verification of no income
  • Eviction notice (where applicable)
Drop files here or
Accepted file types: jpg, gif, png, jpeg, bmp, pdf, Max. file size: 5 MB, Max. files: 10.
    Please upload a copy of the photo IDs, social security cards, or other valid identifying documents you have available for all household members.
    Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.
    Drop files here or
    Accepted file types: jpg, gif, png, jpeg, bmp, pdf, Max. file size: 5 MB, Max. files: 10.
      Please upload a copy of your DD-214 if available.
      Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.
      Drop files here or
      Accepted file types: jpg, gif, png, jpeg, bmp, pdf, Max. file size: 10 MB, Max. files: 4.
        Please upload your last 2 payroll stubs, or your last statement for any unemployment insurance, SSI, SSDI, VA Disability Compensation, private disability insurance, Worker’s Compensation, TANF, retirement, pension, child support, alimony, or any other regular income source.
        Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.
        Drop files here or
        Accepted file types: jpg, gif, png, jpeg, bmp, pdf, Max. file size: 10 MB, Max. files: 2.
          Please upload any formal notices from the landlord, magistrate, or other supporting documentation.
          Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.