Open Arms

Open Arms Intake Form

This intake form will help the Open Arms resource navigator gather essential information to provide tailored support and resources for the client's successful relocation.

"*" indicates required fields

Intake Volunteer
This field is hidden when viewing the form
Intake Date
This field is hidden when viewing the form
Please select the Seeking Assistance form to use as a basis for this intake.

Personal Information

Name You Use*
Is the name above the same as shown on your current driver license/ID?*
(We may ask for your legal name at some point, but we don’t need it here.)
Date of Birth*

Contact Information

May we send you text messages?*
Address*
Who's moving?*
Please enter one person per line, and include their name, pronouns, and age.
Are you (or one or more of your family members) gender diverse, such as transgender or nonbinary?*

Relocation Details

Our staff and volunteers are not emergency responders, lawyers, social workers, licensed therapists, or medical providers. If you are in need of more immediate or intensive assistance, please contact a crisis resource such as the Trevor Project, the Trans Lifeline, 988 Suicide and Crisis Line, or find a LGBTQ+ inclusive resource near you through the InReach directory.

Do you know where you want to relocate?*
Do you have friends or family in the desired relocation state you can coordinate with locally?

Support and Resources Sought

Housing Needs*
Check all that apply.
Medical and Mental Health Needs*
Check all that apply.
Do you need help finding a job?*
Do you need legal support?*
Do you need financial support?*

Additional Information

This field is for validation purposes and should be left unchanged.