Wyoming Homeless Collaborative
What is WHC Coordinated Entry? How will my information be used?
WHC Coordinated Entry is a collaboration through which participating agencies collectively measure and plan for the needs of individuals and families experiencing homelessness in Wyoming.
With your permission, you will be assessed by a staff person or volunteer for an agency that participates in WHC Coordinated Entry. The results of your assessment will be entered into a database called the Homeless Management Information System (HMIS).
You have the right to decline to participate. If you opt to participate, your assessment results will be provided to the Coordinated Entry Team -- a multidisciplinary team that facilitates referrals to several housing projects. If a project opening is identified for which you are potentially eligible to be prioritized, attempts will be made to reach you at the contact information you provide so that you can undergo project-level assessment.
Homeless Prevention Services: Assessment for homeless prevention services may or may not be assessed through the coordinated entry process.
What agencies currently participate in some aspect of WHC Coordinated Entry?
Wyoming Homeless Collaborative
Consumers Informed Consent & Sharing of Information Authorization
understand information about me and/or my dependents listed below is entered into a database system called ServicePoint. This system helps to better understand homelessness, to improve service delivery and to evaluate effectiveness of services provided. Participation in data collection is a critical component of our community's ability to provide the most effective services an housing possible.
The information that is collected is protected by limiting access to the database and limiting what information may be shared. Access to the data and sharing of the data is in compliance with the standards set by the federal, state and local regulations governing confidentiality of client records. Every person and agency that is authorized to read or enter information into the system has signed an agreement to maintain the security and confidentiality of the information.
List all Dependent Children, under 18, in the household, if any:
By signing this form, I authorize the following:
The information collected by this agency will be included in ServicePoint and only partner agencies, which have entered info an HMIS Agency Participant Agreement at which I have obtained or sought out services, may use my information to...
- Produce a client profile at intake that will be shared with collaborating agencies
- Produce aggregate level reports regarding use of services
- Track individual program-level outcomes
- Identify unfilled service needs and plan for enhancements
- Allocate resources among agencies engaged in services
By signing this form, I authorize the following:
I authorize the partner agencies and their representatives to share basic information regarding my family members listed below and/or me. I understand this information is for assessing my/our needs for housing and other services.
I Understand That:
The partner agencies have signed agreements to treat my information in a professional and confidential manner. I have the right to view the client confidentiality policies used by the HMIS partner agencies.
Staff members of the partner agencies who will see my information have signed agreements to maintain confidentiality regarding my information.
The release of my information does not guarantee that I will receive assistance; my refusal to authorize the use of my information does not disqualify me from receiving assistance.
My records are protected by federal, state, and local regulations governing confidentiality of client records and cannot be disclosed without my written consent unless otherwise provided for in the regulations.
This authorization will remain in effect until I revoke it in writing; I my revoke authorization at any time. If I revoke my authorization, all information about me already in the database will remain.
This release will remain in effect for 1 year from the date this ROI is signed.
Auditors or funders who have legal rights to review the work of this agency may see my information in HMIS related to the services I received and funded by their Department(s).
This document is to certify that the above-named applicant or household has explored all re-housing options and all available resources. The case manager also certifies that a comprehensive assessment was completed and that the findings are such that the above-named applicant or household would become or remain homeless but for ESG Homelessness Prevention or RRH assistance.
Client Certification
All Rights Reserved.