This form is to be used and submitted by approved ISD partners only.
If you are an individual in need of furniture assistance, DO NOT complete this form. Please visit the Partner Agencies page at https://www.dallasfurniturebank.org/partner-agencies to contact a partner agency for assistance.
Non-referral submissions will be voided.
The information recorded in the form will be maintained with strict confidentiality and will only be used by DFB Staff for processing furniture requests, making contacts for outcome measures and for reporting demographic/statistical information.
If a household has more than six (6) children in need of a bed, please provide the age and sex of additional children in the box below.
Client Demographic Information
The following information is used for reporting only.
Please provide any additional information or needs.
By submitting this form, I acknowledge that the child(ren) referred do not have a bed or their current bed/sleeping arrangement poses a potential health risk.