This packet includes the Client Intake form (that you will fill out with the client), the Release of Information Form (that the Neighbor needs to sign), and the ZCHC Staff intake and outcome form (that the ZCHC staff/volunteer will fill out on their own).
Below, you can find each piece as a seperate word doc if you do not need the entire packet.
This is the form that we use to gather information on Neighbors needed to properly assess and assist in their case, as well as the information needed for grant records. If you are going to print the form out and then handwrite the information, then please click 'To Print' above. If you are going to fill out the form via your computer or your tablet, then please click 'Computer User' above.
Used in order to share information with one another or other resource organizations given to us by a Neighbor.
This form is for ZCHC staff and volunteers to fill out with their conclusions for each Neighbor and their case.
2. Proof of income must be collected for each Neighbor. Please scroll down to the Proof of Income section for the documents that qualify.
2. Both the Intake Form and the proof of income must be uploaded into ServWare.
4. Assistance items (such as rent paid, connecting to resources, mediation sessions, etc.) must be logged into ServWare.
You will recieve an email from ServWare and a text from Sarah O'Donnell that you have been assigned to listen to a voicemail on Nationbuilder.
1. Log into Nationbuilder.
2. Go to the Communication tab on the left side and click on Think Tanks on Poverty
3. Click on the Voice tab to listen to the voicemail.
4. Once you have called the Neighbor back, then complete the assistance item in ServWare with your notes and the information you have collected. Instructions on how to complete a call request can be found under the ServWare section of this page.
Conference User Guide.pdf - This is a large guide created by ServWare for users.
How to login:
Login: Click here
Username and Password information can be found here.
How to complete a call with a Neighbor
1. Log into ServWare here.
2. Click the Requests tab
3. Click Edit on the open request.
4. Under Status, mark Complete
5. Record any notes under Request Notes
6. Check Visit Complete
7. Fill out Hours
8. Fill out Scheduled Date
9. Fill out Time
10. If the assistance item is a referral, click Referral Information above the Save and Cancel buttons
11. Click Rerrered to Agency and specify which agency under Agency 1, Agency 2, Agency 3, Agency 4
10. Click Assistance
11. Click New Assistance Item
How to make an assistance request for a Neighbor
1. Click on the Neighbor tab
2. Use the Search bar to look for the Neighbor
3. Click the Req button on the Neighbor line
4. Fill out Status
5. Assign the assistance to a ZCHC Volunteer in Assigned To
6. Record any notes for the Request in Request Notes
7. Mark Other in Visit Details
8. Assign the visit to a ZCHC Volunteer in Assigned To (1)
Either the community outreach coordinator, tenant/landlord mediator, or a volunteer with ZCHC will initiate contact with a neighbor who ZCHC can assist.
The person who initiates contact (this includes the person who listens to the Neighbor's voicemail) is responsible for initiating and carrying out the intake process. If the person who initiates contact cannot carry out the intake process for whatever reason, then they must designate a proxy to take their place. Either the person who initiated the contact or their proxy will be assigned to enter both the neighbor’s information, the request, and relevant documents into ServWare.
1. Contact is made with a potential Neighbor. For example, the point of contact can be a ZCHC volunteer listening/answering a voicemail that a potential Neighbor has left, or a potential Neighbor approaching a ZCHC volunteer on another platform.
2. The person who made the initial contact (or their proxy) will fill out the Intake Form (computer use HERE - for printing HERE) with the neighbor. This can be done in person (with proper PPE protocols), over the phone, or through Zoom.
The neighbor may contact you via phone or in some other situation where you do not have the intake form onhand. In that case, it’s recommended that you 1) get as much information in the moment as possible and then 2) schedule a time where you can speak to them directly to fill out the Intake Form.
3. The neighbor will need to sign a Release of Information Form. The initial contact (or their proxy) is responsible for this step. The Release of Information Form allows us to discuss the neighbor’s case and circumstances freely. There are two options for them to do this, 1) printed and signed or 2) through DocuSign.
If you are in a position to print the Release of Information Form, please CLICK HERE to download the form. This option is preferable, considering that many housing unstable individuals will not have access to the technology needed for DocuSign.
3a. Once you have aquired the signature, please scan or take a picture of the paper form to upload into ServWare. Keep the original in a safe place.
If you must use Docusign, then notify Sarah O'Donnell as soon as possible (email@example.com | 614.549.1759) so that she may send the Docusign Link to the appropriate email for the Neighbor to sign.
4. Input the Neighbor's details into ServWare.
Proof of Income
In order to satisfy our grant, we must prove that the Neighbors we are helping have Low to Moderate Income. These documents must be uploaded into ServWare under each Neighbor's name. Below is a list of acceptable documents that prove Low to Moderate Income status:*
*If a neighbor is homeless, then they are automatically shown to be Low to Moderate Income.
- Pay stub
- Job and Family Services Statement
- Medicaid Card
- Statement of unemployment benefits
- SNAP Card
Please take a front and back picture or scan of these items, and then upload them into ServWare.