Client Intake Form

Please complete the form below. All information is confidential and will only be shared with authorized People 4 People staff .

Client Information

Full Name *

Date of Birth *

Phone *

Email *

Address *

Preferred Language

Emergency Contact (Name & Phone)

Reason for Seeking Advocacy

Primary Issue / Concern *

Detailed Description of the Situation *

Relevant Dates / Timeline

Desired Outcome / Goals *

Current Support System

Family Members Involved

Friends / Community Support

Other Organizations / Agencies Involved

Client's Background

Education Level

Employment Status

Housing Situation

Medical History (if relevant)

Mental Health History (if relevant)

Legal History (if relevant)

Additional Notes

Any other information you think is important

If you have questions about the form, email us at info@people4people.org or call (413) 273‑6563.