CES TEST PAGE March CES 2020 Form Name* First Last Phone*Email Preferred Method of Contact* Phone Call Text Walk-In (In-Person) If you have a phone, what type of phone plan do you currently have? Unlimited Minutes and Text Limited Minutes and Text Wi-Fi Only Associated Ministries will be open for walk-in appointments Mondays, Tuesdays, Thursdays and Fridays from 9:00 a.m. to 3:00 p.m. (closed for lunch from 12:00-1:00)Where did you sleep last night?*Select one.OutdoorsShelterOwn apartmentSomeone else's apartmentHotelTreatment ProgramJailHospital or InstitutionOtherYou have selected other. Please explain.* What city did you sleep in last night?* Are you currently in fear of your safety due to domestic violence?* Yes No
