Housing Resource Referral Form and Checklist

DBHDS Housing Resource Referral Form

Please click here to download the DBHDS Housing Resource Referral Form (dated 5/2018).

Please click here to download a sample referral form.

Please note that the DBHDS Housing Resource Referral Form is updated periodically, so it is important that you download the form from this website each time that you make a referral. This ensures that you are using the correct version of the form. The referral form is in a fillable PDF format, so therefore support coordinators can type their information directly into the form to ensure the form is legible. We will not accept any illegible forms.

Support Coordinator/Case Manager Checklist

The Support Coordinator/Case Manager checklist enumerates the tasks support coordinators and private case managers should complete with individuals to ensure they are prepared to use housing resources (e.g., housing choice vouchers, SRAP, etc.) in a timely manner; if they are referred.

Please click here to download the checklist.

Submission of a referral occurs after a variety of tasks have been accomplished. This is important: performing these steps first increases the likelihood a person will be prepared to use the housing resource, and decreases the chances a person will be determined ineligible or decline the housing resource after it is offered.

If you need assistance with helping someone transition, please contact a housing specialist in your region, Please click here for their contact information.

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