HOMELESS HOUSING ASSISTANCE PROGRAM HOW TO REFER A FAMILY

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1 Building Community, one friend at a time. HOMELESS HOUSING ASSISTANCE PROGRAM HOW TO REFER A FAMILY Thank you for your interest in referring a family for homeless housing assistance at Friendly House. Please complete the following information. The forms may be faxed back to our office attn: Community Services. Please Note: Referrals are only accepted when the waitlist is open. Please check the Friendly House website, before referring a family. The waitlist may be open for only 1-2 days at a time. The process will be as follows: 1. Referrals will be evaluated for eligibility. 2. A confirmation receipt will be faxed back to you within 10 working days. The confirmation will also state if the family is eligible for further review. Please make sure you include a fax number. 3. Eligible families will be added to the waiting list. Placement on the waitlist does not guarantee the family will receive assistance. 4. The referring agency and/or the client will be notified once an opening occurs. 5. s are kept on the waitlist for 2 months. The referring agency must contact Friendly House if additional time is needed. 6. Families must meet all eligibility criteria when their name reaches the top of the waitlist. If the family has already moved into housing, most likely they no longer meet the eligibility criteria for homelessness. Please be careful when referring families into our program. We stress we are a full service program and not just rent assistance. We have many expectations for the family and our program takes a lot of work to successfully complete. Only homeless families may be referred (see definitions for further explanation). In addition, families may be denied for the following reasons: 3 or more evictions, violent offenses, registered as sex offenders, manufacturing of a controlled substance charge, or with an open warrant. Knowingly giving false information results in immediate denial of the application. If you have any further questions, please visit our website at or call Friendly House Housing Assistance Referral Form. Sept of 10

2 HOUSING ASSISTANCE PROGRAM SUMMARIES 1. Rapid Re-Housing With the support of a case manager, the family searches for a market rate apartment. Once a family is approved for move-in, Friendly House provides partial to full rental assistance for the first six months in the apartment (deposits are not an eligible cost). This program is designed for families with few barriers to permanent housing. There will be an estimated 22 openings between July 1, 2010 and June 30, In order to qualify, the homeless family must also meet the definition of housing ready (see definitions for further explanation). 2. Transitional Housing Families move into a two or three bedroom apartment in North or Northwest Portland. Friendly House pays the security deposit and full rental amount. The family is eligible to remain in the apartment for six months, with the possibility of extension for up to one year. The family must pass all screening criteria of the property manager. This program is designed for families with intermediate level barriers to permanent housing. There will be an estimated 8 openings between July 1, 2010 and June 30, Homes Not Beds Families receive $10,000 in housing assistance and supportive services. With the support of a case manager, the family searches for a market rate apartment. The family may use the housing assistance money for application fees, move-in costs, rent, and supportive service costs. This program is designed for families with multiple barriers to permanent housing. There will be an estimated 2 openings between July 1, 2010 and June 30, In order to quality, the homeless family must meet the definitions of chronically homeless and head of household with disability (see definitions for further explanation). Please note: all programs include long-term case management and support services. Support services consist of assistance such as household items, access to furniture, food, transportation, and other resources, as well as life skills and training opportunities. Program dollars may not be used to help a family continue in their current apartment. If a family facing eviction wishes to stay in the same apartment, please call for a list of agencies offering rental assistance. Friendly House Housing Assistance Referral Form. Sept of 10

3 DEFINITIONS Chronically Homeless Has been homeless (not including time spent with family or friends) for at least six months over the last three years. Family One or two parent* household with at least 1 child age 17 or under, in their care One or two parent* household with a verified pregnancy (must be in the 3 rd trimester or a high risk pregnancy). *The parent must be at least 18 years of age Head of Household with Disability Adult caretaker in household has verifiable physical or mental disability, including those caused by alcohol or drug use. Homeless Persons living in the streets, cars, abandoned buildings and places not fit for human habitation Persons in imminent risk of homelessness - eviction within a week Homeless who are about to be released from out-patient care (including treatment) or hospitals where they have been for less than 30 days Person in hospitals or institutions for periods of more than 30 days but within a week of discharge with no identified residence, resources or support network Persons incarcerated with a fixed release date and no residence identified Youth who are not currently in state foster care Housing Ready Family has verified source of income (or future income) to pay full rent after housing assistance ends. This may consist of income through employment or assistance through another agency, SSI/SSD, a TA-DVS grant, etc. Please note: A family is not considered housing ready if TANF is their sole source of income. Friendly House Housing Assistance Referral Form. Sept of 10

4 HOUSING ASSISTANCE REFERRAL FORM PART A: (To Be Completed By Referring Agency) of family being referred: of person completing referral: Agency name: Phone #: Position: Fax #: How long have you known this family? How did you begin working with this family? What services are you providing for the family? What services will you provide for the family after placement into housing? What are the family strengths? Are there any concerns we should be aware of regarding the family: Interpreter: Yes No Language: Friendly House Housing Assistance Referral Form. Sept of 10

5 PART A: (Continued: To Be Completed By Referring Agency) Before submitting referral to Friendly House Community Services, please make sure the referral contains the following information. All boxes must be checked in order for the referral to be accepted. Contact information for the referring agency and referred family provided. Family meets all eligibility requirements for the housing assistance program(s) they are applying for. Verification of Homelessness (must include a letter on agency letterhead). Please see definition of homelessness on Page 3. Information regarding family income source and amount (if any). Please indicate if family is receiving agency or grant assistance, such as TA-DVS. Friendly House waitlist is currently open for the housing assistance program(s) that the referred family is applying for. Friendly House Housing Assistance Referral Form. Sept of 10

6 PART B: (To Be Completed By Family) : Please describe your current living situation (DV shelter, treatment center, staying with family or friends, etc.): Complete information below: Street : City : Zip Code: Contact Phone #: Second Phone #: Length of Stay: How much longer can you be there? Please list all family members who will immediately move into the household. PERSON 1 SELF PERSON 2 Veteran Yes No Veteran Yes No Friendly House Housing Assistance Referral Form. Sept of 10

7 PERSON 3 PERSON 4 Veteran Yes No Veteran Yes No PERSON 5 PERSON 6 Veteran Yes No Veteran Yes No Please copy form and attach additional family member information if necessary. Friendly House Housing Assistance Referral Form. Sept of 10

8 Are there any other family members not currently in the household? Yes No If yes, when will they be returning? Explain why family member is not currently in the household. How did you become homeless? Is this the first time you have experienced homelessness? Yes No If not, how many times have you experienced homelessness in the past? What challenges have you faced in renting a place on your own? Do you have any evictions on your record? Yes No If yes, please complete chart below: Date Explanation of why evicted City/state What steps have you taken to overcome homelessness? Friendly House Housing Assistance Referral Form. Sept of 10

9 List all felonies and/or class A misdemeanors Not Applicable Charge(s) Convicted?(Yes/No) Year Are you currently on parole/probation? Yes No If yes, name of probation/parole officer: Phone: Are you currently employed: Yes No If unemployed, looking for work: Yes No If employed (mark all that apply): Permanent Temporary Seasonal Full time (35+) Part time On-Call Hours worked last week: How much was your income (not counting food stamps) in the last 30 days? From what sources?: Source Amount ($) TOTAL $ Do you receive food stamps? Yes No If yes, how much per month? Do you have an active TADVS (Temporary Assistance for Domestic Violence Survivors) grant? Yes No If yes, when does it expire? Please explain in your own words what you hope to gain from participating in our homeless program: Friendly House Housing Assistance Referral Form. Sept of 10

10 Please read the program summaries and check the box next to the program(s) which best fits your family s needs. Note: The waitlist may not be open for all programs at this time. Please refer to the Friendly House website, for more information. 1. Rapid Re-Housing Please explain how you would pay for rent when the six months of housing assistance ends: 2. North/Northwest Transitional Housing 3. Homes Not Beds Please list how many months you have been homeless over the last three years: Please describe how you meet the definition of head of household with a disability: By signing this referral form, I understand that the information is true to the best of my knowledge. I am recommending the family to the housing assistance program and I believe they will make the necessary changes to improve their homeless situation. Signature of applicant Date Signature of referring staff person Date Friendly House Housing Assistance Referral Form. Sept of 10

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