Housing Referral Form

Thank you for your interest in services through Strategies to Empower People. Filling out the form below will formally place a referral for possible services. As a note of information, our agency has received, and is processing a high volume of referrals for assessment at this time, so a referral may take longer than anticipated. Submitting a referral does not mean active services, and someone from the respective unit will reach out once the referral has been reviewed.

Something to keep in mind when sending over a referral for consideration:

  • First STEP Housing Access is not an emergency service, while we may be able to help in finding and securing a unit or placement we do not have “Move-in Ready” units on hand.
  • Purchase of Service for Assessments are typically 15 hours, and a SEPARATE purchase of service (60 Hours Annual) will be needed upon acceptance into the program. Receival of a POS does not mean active services
  • Program staff will reach out once referral has been reviewed to start the process for possible services.
  • Service code for our program is 089
  • Vendor code for our program is HA1281
  • Good contact information for the client, and a high level of participation from members of the planning team leads to the best chances of our team in being successful in obtaining housing that meets the needs of the individual served.

CLIENT INFORMATION

Conserved

REGIONAL CENTER INFO

PRIMARY/FAMILY CONTACT INFO

LIVING SUPPORTS

Type of Services
Type of Services

SERVICE REQUESTED

Housing is need for:
Area for Services
Reason for Referral:
Emergency Assistance

Below are the requested documents we ask to be added to the submitted referral.

Requested Documents

Describe in detail what the situation is: