Home - TCHC CES Assessment

Online CES
Assessment (Below)CES Assess Point
843-492-2600 Veteran Housing Services
843-492-2594 Other 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.

Are you a Veteran of the US Armed Forces?*

What county are you currently located in?*

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:

Please select the situation that best describes your current experience.

I am currently unhoused

I am fleeing a domestic violence situation

I am being evicted

I am 18-24 years old and experiencing housing insecurity.

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

This describes my situation

I am fleeing a domestic violence situation

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

This describes my 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.

This describes my situation

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.

I agree to allow for my information to be entered into a secure and encrypted database. I also understand that I may be contacted by a coordinating service provider regarding my housing crisis.

Contact Information

Contact Phone*

No Phone

I do not have a phone

Email Address*

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*

Relationship to Alternate Contact*

Alternative Contact Phone*

Is an agency or person assisting you with this application?*

Name of Person Directly Assisting You*

Contact Number for Person Directly Assisting You*

Name of Assisting Agency or Organization*

HIDDEN CALC

Confirm Information

Current County: Update information

Veteran Status: Update information

Current Living Situation: Update information

Email Address: Email Required Update information

Please complete all fields to continue.

Demographic Information

Your Name (Head of household)*

Age

Date of Birth*

Social Security Number

Sex*

Veteran Status

Gender

Select all that apply.

Additional Gender Detail (Optional)

Race and Ethnicity*

Additional Race and Ethnicity Detail (Optional)

Primary Race

Secondary Race

Ethnicity

Do you have a long term disabling condition?*

Select any long-term disabling conditions that you identify as having*

Alcohol Use Disorder

Substance Use Disorder

Chronic Health Condition

Developmental

HIV / AIDS

Mental Health Problem

Physical Disability

No Disabling Condition

Other / Don’t Know / Prefer not to answer

Are you currently employed?*

Do you have health insurance?*

Household Information

Number of People in Household (Including Yourself)*

Please enter the total number of persons experiencing a housing crisis.

Please enter a number from 1 to 10.

Additional Household Members

Name	Relationship to Head of Household	Actions

There are no Household Members.

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.

HH Number Difference

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.

Is anyone in the household currently pregnant?*

Approximate Due Date

Select any non-cash benefits received:

SNAP

WIC

Child Care Vouchers

TANF Transportation

Other TANF Services

Please complete all fields to continue.

Current Situation

Have you ever experienced domestic violence?*

Are you currently fleeing domestic violence?*

When did the domestic violence experience occur?*

Do you need a confidential location to stay?

Where did you sleep last night?*

How long did you stay there?*

Before entering the previous situation where did you sleep?*

Will you be (or have you been) discharged without a housing destination?*

Approximate Discharge Date*

Do you have an eviction notice from the landlord or magistrate?*

Landlord

Magistrate

No Notice

Must vacate by date*

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.

Total months in last 3 years experiencing homelessness*

Number of episodes in past 3 years experiencing homelessness*

Have you ever identified as having an issue with substance use (either drugs and/or alcohol)?*

Are you interested in shared temporary housing until a permanent housing opportunity is available?*

If housing became available in another county would you be willing to move?*

Do you identify as being a member of the LGBTQ+ community?*

Select which of the following items you currently have:

State Issued ID, Driver’s License, or Passport

Social Security Card

On a regular day where and when is it easiest to find you?*

Current Address*

Street Address Address Line 2 City State ZIP Code

What is your current monthly rent amount?*

Please enter a number greater than or equal to 1.

How many bedrooms is your unit?*

Included Utilities

Place a check mark by any utilities that ARE included in your rent.

Electricity

Water / Sewer

Other

Tell us more about your situation

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

Total Monthly Household Income*

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.

HP Scoring

HP Scoring Information

In the past 6 months have you experienced a sudden and significant decrease in income or an unavoidable increase in non-discretionary expenses (e.g., rent or medical expenses)?*

In the past 12 months have you experienced a major change in household composition (e.g., death of a family member, separation/divorce from adult partner, birth of child)?*

How many formal rental evictions have you had that resulted in the loss of housing within the past 7 years?*

How many times have you experienced homelessness (living in a shelter, on the street, or in transitional housing) in the past three years?*

Do you have any criminal felony offenses against persons or property that may interfere with obtaining a new lease?*

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)

Upload Identifying Documents

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.

Upload DD-214

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.

Upload Income Documentation*

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.

Upload Notice to Vacate*

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.

Coordinated Entry System Assessment

Service Area

Getting Help Through Coordinated Entry System

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

Privacy Statement

Contact Information

Confirm Information

Current County: Update information

Veteran Status: Update information

Current Living Situation: Update information

Email Address: Email Required Update information

Please complete all fields to continue.

Demographic Information

Household Information

Please complete all fields to continue.

Current Situation

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.

Please complete all fields to continue.

Additional Information

HP Scoring

Please complete all fields to continue.

Additional Information

Acuity Tool

Please complete all fields to continue.

Documentation