Balance of State Continuum of Care
Homeless Planning Region 16
The Community Action Commission of Fayette County, in partnership with homeless planning region 16, presents the Coordinated Entry process on this page. The purpose of this page is to serve as a starting point for any individuals and service providers seeking information on how to access the homeless crisis response system in Clinton, Fayette, Highland, Pickaway, and Ross Counties. Please continue to visit this website for details and updates.
These programs serve all households regardless of race, color, national origin, religion, sexual orientation, gender identification, age, familial status, or disability.
Community Resources for the Homeless & At-Risk
Region 16 Housing Inventory Chart 2017
Available Housing List
Clinton County Specific Resources
Fayette County Community Resource Guide
Fayette County Available Housing List
Highland County Specific Resources
School Homeless Liaison Contact Information
Pickaway County Specific Resources
Ross County Specific Resources
Region 16 Management & Structure
Coordinated Entry (CE) Documents
The Coordinated Entry (CE) File is the common file shared among all homeless service providers in the region & is required to be completed for ALL referrals.
- CE Checklist– This form is to track required documents needed for the CE File.
- HMIS Diversion Form 2.2019 – This form is completed once, for the HoH only, by the access point. This form must be included with ALL referrals.
- 2018 HMIS Unsheltered form – This is required ONLY if household cannot be diverted from homelessness, but shelters are full and/or the individual refuses shelter services. (HMIS or paper copy provided here)
- Single, Family & TAY VI-SPDAT – This is completed in HMIS & the required SPDAT score will be present on the HMIS referral required in the CE File.
- HMIS-Intake-Form-All-Programs – This is completed in HMIS & can be printed out or use the paper copy provided here.
- Regional-Universal-Release-Form – This form must be completed by access point or homeless service provider.
- HMIS Release Consent forms– These forms must be completed by access point or homeless service provider.
- Homeless Status Documentation This form must be completed by access point or referring homeless service provider.
- Income & Supports Verification – These forms must be completed by access point or homeless service provider.
- PSH Documentation for non-PSH Programs – These forms must be completed by agencies referring participants to PSH.
- Case Closeout and Termination of Assistance – Copy must be included in file and given to client.
- Region 16 Grievance Policy – Copy should be posted and given to client.
- Protect Yourself from Lead Brochure – Copy should be given to client and documented in Housing Inspection tab if applicable.
- Landlord Benefits – Copy should be given to client to give to prospective landlords.
Rapid Re-Housing Forms
Permanent Supportive Housing Forms
PSH Documentation for PSH Programs
TAB 2 – ENROLLMENT PSH
Tab 3 – Housing Inspection PSH Tab 3 – Housing Inspections Updated March 2017
TAB 4 – FINANCIAL ASSISTANCE PSH
TAB 5 – RECERTIFICATION PSH
TAB 6 – CASE MANAGEMENT PSH
CAC PSH Programs
Brochures & Flyers
Region 16 is comprised of Clinton, Fayette, Highland, Pickaway, and Ross Counties. In the document below, you will find basic information regarding the economic and demographic conditions in the area. Regional and community partners may utilize this information in the development of proposals for funding.