Emergency Shelter Exit Interview
Client Information
Client Name
Client ID/Case Number
Date of Exit
Exit Details
Reason for Exit
Completed Program
Left Voluntarily
Asked to Leave
Transferred
Other
Destination After Exit
Did client receive referrals/resources?
Yes
No
If yes, please specify
Client Feedback
In your opinion, what did you find helpful about your stay?
What could be improved?
Additional Comments
Staff Notes
Notes/Observations
Staff Name
Date