WHSS Initial Referral Form

CW Solutions is a No Wrong Door Agency and is an active member of the Coordinated Entry system. The Wisconsin Housing Support Services (WHSS) Program assists eligible, enrolled families in locating safe, affordable housing that meets their family’s needs in accordance with program requirements, within Lincoln, Marathon, and Wood counties.

This is the first of two steps in our referral process. All information shared will be held confidential.

Name of adult(s) in the household being referred:

Number of adults in the household:

Number of children in the household that are claimed as tax dependents:

Is a household member pregnant?

YesNoUnsure

Phone number:

Email address:

Current address or location where the household is residing or staying:

Please explain the current housing situation, if possible:

County where the household would like to find housing:

LincolnMarathonWood

I am starting this referral process

For myself and my family.On behalf of a family, and they are aware that I am completing this form.For another family, and they are not aware that I am completing this form.

If you are completing this form on behalf of/for another family, please provide your name and agency/organization:

If you start the referral process on behalf of or for another family: please note that we will not be able to discuss the status or other details about the household with you until a Release of Information is signed.

Thank you for taking the time to provide this information! To finish our referral process:

We will send forms that need to be filled out to determine if you are eligible for WHSS.The forms will be sent to the email address you provided above and can be completed electronically. If you did not provide an email address, we will call you to find another way to get the forms to you.

You have the option to complete the Coordinated Entry process, which could refer your household to more housing programs.To complete this step, call our Housing Referral & Resource Line.

Housing Referral & Resource Line: 715-218-2887

Monday through Friday, 8am-4:30pm

We look forward to connecting with you soon!

This institution is an equal opportunity provider.