Please note that all jail referrals must meet the HUD definition of literally homeless: exiting an institution where (s)he has resided for 90 days or less and who resided in an emergency shelter or place not meant for human habitation immediately before entering that institution. https://www.hudexchange.info/resources/documents/HomelessDefinition_RecordkeepingRequirementsandCriteria.pdf


Please complete this Information Sharing Agreement with the client prior to filling out the referral form.

Name *
Name
What was the date that this person began experiencing homelessness?
What was the date that this person began experiencing homelessness?
Signed Information Sharing Agreement upload
NOTE: Please re-name all files to include client name and date of completion. Ex:john-smith-2019.01.17.pdf

*As a recipient of federal funding, One80 Place is prohibited from assisting with the discharge of a person from an established system of care that will immediately result in homelessness – residing in the homeless shelter. Systems of care include, but are not limited to, hospitals, prisons, jails, substance abuse treatment centers, foster care, and mental health facilities.