AS OF 06/17/2025 WE ARE NOT ACCEPTING ANY HOUSING SUSTAINING/TRANSITION CLIENTS AT THIS TIME PLEASE TRY BACK AUGUST 1, 2025

Client Name

First Name

Last Name

Client Date of Birth

Client Phone Number (No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.)

Client Email

Referring Person

Referring Person's Name (if not self)

First Name

Last Name

Have you lived in a shelter and completed a coordinated entry assessment in the past 12 months

Do you have active Medical Assistance in Minnesota

Do You Have A Housing Focused Person Centered Plan?

Do You Have A Professional Statement of Need?

Do You Have A CSSP or Care Plan

Organization/School (if applicable)

Preferred Method Contact for Intake

Phone number to call or text for intake scheduling (No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.)

(###-###-####) *Message and Data Rates May Apply*

Email for Intake Scheduling

Message