AGENCY REFERRAL FORM

Submit a Housing Referral

Case managers, Veterans organizations, nonprofits, government agencies, housing navigators, and community organizations can refer potential participants and inquire about vacancies. The referring organization must confirm it has appropriate authorization to submit personal information about the individual.

Referring organization

Tell us about your agency.

Agency / organization name *

Agency type *

Contact person *

Title

Phone *

Email *

Website

Participant / applicant

Information about the individual being referred.

Applicant / participant name

Applicant contact information Where authorized.

Desired move-in date

Preferred geographic area

Housing type needed

Program / funding source

Approximate authorized housing budget

Expected duration of assistance

Case manager

Case manager contact information

Accessibility / accommodation information relevant to housing

Is funding currently approved?

Is documentation available?

Urgency level

Additional housing requirements

Referral notes

I confirm that the referring organization has appropriate authorization to submit personal information about the individual referenced in this referral. *

For referral partners

Referrals are routed as priority notifications to the designated ULDG housing coordinator. Establish an ongoing partnership to receive vacancy notifications and streamline future referrals.

Authorization required

Only submit personal information about an individual when your organization has the appropriate authorization to do so. Do not include medical diagnoses or sensitive health records through this form.

Submitting an inquiry or referral does not guarantee acceptance, eligibility, placement, or availability. Each inquiry is evaluated according to the requirements of the applicable housing program, property, funding source, services available, and applicable laws.