Dear "hcj25":
Well, it could be a big deal or a small deal.
You said "intake coordinator". Depends upon what you are taking in and for whom. Tomatoes for Gristedes, who cares. Little children for the gooferment, everyone might care.
My first take was "honest mistake" or "deliberate lie"? On a government application or some standard application form that's been xeroxed a grazillion times?
If it's a gooferment form, does it say anything down at the bottom where you signed about perjury? Did it have to be notarized? Was it "official" like a permit to "intake children"? Then, I'd suggest that you need a lawyer; not Yahoo Answers. If not, then you might be able to apologize your way out.
Assuming that it is NOT, repeat NOT, about perjury, gooferent forms, or something that can get you in a lot of hot water (and that's a big deal!), I have some thoughts.
I'd forget about it unless it comes up again. (And resolve in the future to fill out all forms as if they were important. Very important.) If it comes up again, apologize profusely, offer to correct the form, and ask what you can do to compensate for making a mistake.
You might want to have some thoughts, about why you made the mistake, in case things get intense. Treat it as a typo. Think about how rushed you were filling it out. Maybe someone said "don't worry about the exact dates". Maybe you were interrupted by the interviewer being ready. Get the incident firmly in your mind now in case it becomes urgent.
Then forget about it.
Hope this helps. I'm interested how it works out for you. Drop me a note sometime. I have jobsearch hints on my blog if you need them.
Ferdinand J. Reinke
Kendall Park, NJ 08824
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