Discharged from Prison Unable to Pay Rent Mortgage ○ ○ Does Not Apply to Me Client doesn't know ○ ○ Family Member or Personal Illness Client refused ○ ○ Problems Other ○ ○ Did you relocate to Colorado/Colorado Springs? No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○ If yes, why (select all that Care of sick relative Family Support ○ ○ Climate Medical Needs ○ ○ Colorado marijuana laws Natural Disaster ○ ○ Driver's Licenses/Identification Cards for Immigrants Needed services ○ ○ Employment Domestic Violence ○ ○ CONTACT INFORMATION [Optional- can be entered in Location Tab] Number Email DESTINATION ADDRESS (ZIP REQUIRED) Street City Zip Code Signature of applicant stating all information is true and correct Date
○ Discharged from Prison ○ Unable to Pay Rent Mortgage ○ Does Not Apply to Me ○ Client doesn't know ○ Family Member or Personal Illness ○ Client refused ○ Problems ○ Other Did you relocate to Colorado/Colorado Springs? ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected If yes, why (select all that ○ Care of sick relative ○ Family Support ○ Climate ○ Medical Needs ○ Colorado marijuana laws ○ Natural Disaster ○ Driver's Licenses/Identification Cards for Immigrants ○ Needed services ○ Employment ○ Domestic Violence CONTACT INFORMATION [Optional- can be entered in Location Tab] Number Email DESTINATION ADDRESS (ZIP REQUIRED) Street City Zip Code Signature of applicant stating all information is true and correct Date