Moab House Referral Form

  • Moab House Referral Form

    This form will take approximately 10 minutes to complete. Please provide as much detail as you are able.

  • READ CAREFULLY

    To be eligible for Moab House, the Young Adult (YA) must be emancipated from foster care, must be 18-20 years old, may not be a convicted sexual offender, must be WILLING to learn the skills necessary for successful independence, and must be law-abiding.

    Moab House's mission is to provide safe, loving, and productive transitional housing to former foster youth between the ages of 18-21 who have emanipated from the foster care system.

    Moab House is a co-ed dorm-like building geared toward teaching independence and respect for our neighbors. Moab House does not provide emergency placement services. At the end of this form you will be asked for a few meeting dates/times that work best for your schedules. This is so that we can meet your YA and interview them. You and your YA must be able to meet at Moab House, located at 1960 E. Countyline Rd Building 8, Mineral Ridge, OH 44440. Virtual meetings will not be considered. After the initial meeting, we will contact you within 3 business days to give our decision. If your YA changes their mind at any time, we kindly just ask that you let us know. We understand!

    We look forward to meeting your YA!

  • Section 1. Referrer Info

  • Please describe your role:
  • Format: (000) 000-0000.

  • Section 2. Young Adult Info

  • Format: (000) 000-0000.
  • Current Housing*
  • YA Birthdate*
     - -
  • Is the YA 18?*
  • YA Emancipation Date*
     - -

  • Section 3. School

  • Is the YA graduated?*
  • Post-graduation Plans*

  • Section 4. Work

  • Does YA work?*
  • Does YA plan to keep their job after emancipation?*
  • How long have they worked at their current job?
     - -

  • Section 5. Health

  • Is your YA currently in counseling?*
  • Is your YA willing to continue with counseling after emancipation?*
  • Is your YA taking medications?*
  • Is the YA willing to continue taking medications after emancipation?*
  • Rows
  • Does your YA have any physical disabilities/limitations?*
  • Will your YA able be able to live independently mentally and physically at 21?*
  • Is your YA on a medical waiver that makes them unable to work?*
  • Is your FY a convicted sex offender?*

  • Section 6. Bridges Info

  • Is the YA currently enrolled in Bridges?*
  • Format: (000) 000-0000.
  • Reason for Referral*

  • Section 7. Transitional Housing Questionnaire

  • Our "non-negotiable" rules include (but are not limited) to the following:

    • Be willing to be safe, loved, and productive
    • Be law-abiding
    • No visitors in apartments
  •

  • Our complete resident handbook along with other important documents can be found by clicking HERE.

  • Section 8. Initial Meeting

  • Please provide preferred dates and times for an initial meeting and tour of Moab House.

  • Preferred Date/Time #1 Please indicate a preferred date and time for a Moab House Tour. Tours typically take 1 hour.*
     - -
  • Preferred Date/Time #2 Please indicate a preferred date and time for a Moab House Tour. Tours typically take 1 hour.*
     - -
  • Preferred Date/Time #3 Please indicate a preferred date and time for a Moab House Tour. Tours typically take 1 hour.*
     - -
  • Preferred Moab House Move-In Date
     - -

  • At the initial meeting we will review your form and ask any additional questions that we have. This is the perfect time for you and your young adult to ask questions! After that, we will take you on a tour of our building so that your young adult can see where they could be living.

    As a Christian organization, the Moab House team will take 3 business days to pray about the young adult and decide if they would be a good fit for our house. After those three days, we will reach out with our decision by email.

    Upon acceptance, we will have the young adult come to to Moab House on Signing Day to sign all forms (if they are 18), or we will wait until their 18th birthday to have them sign. We will set their move-in date and issue their keys on that day.

     

    We could not be more excited for your young adult! :)

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