HomewardBound Request Form

This is the official request form for the Homeward Bound Relocation Fund. This is only to be used by agency affiliated professionals who provide services to clients (i.e., service providers, such as case managers, social workers, peer supports, outreach workers, nurses, educators, shelter staff, etc.). Self-referrals are not accepted. Funds can only be used to purchase plane, train or bus tickets. If you are looking for relocation assistance and are not currently connected with a provider, please email homewardbound@voaspokane.org to get connected with someone. All other inquiries can also be sent to the aforementioned email address.

Please refer to the following when submitting a request:

Client must identify a safe and stable place to live with friends or family. There does not need to be a timeframe attached to the length of stay; however, the individual offering to house the client should be committed to supporting them in the resolution of their housing crisis indefinitely.
The provider must verify that the client does in fact have a place to stay with friends or family, or a rental of their own, at their desired destination.
The provider must submit a request using this form, and attach all requested documentation to this form. Your submission will not be reviewed unless documents are received.
Clients must have the necessary identification for whatever travel method they choose. Providers must verify this.
Upon receipt of the request, the Fiscal Administrator (FA) may contact the provider to request additional information, if needed, and finalize any details.
The FA will purchase the ticket, subsequently supplying the provider with it. It is the responsibility of the provider to ensure that the client gets the ticket and arrives at the airport/bus station/train station.
All information submitted through the request form will be used by the FA to create a client enrollment in CMIS. If your client wishes to remain anonymous in CMIS, please note that.

VOA is not responsible for missed departures, connections, or failure to reach stability at chosen destination. VOA cannot assist clients in returning to Spokane County.

Requester's Name*

First NameLast Name

Requester's Email*

example@example.com

Requester's Phone Number

Please enter a valid phone number.

I certify that (to my knowledge) the client I am referring to has a place to live indefinitely upon reaching their destination*

YesNo

Where or with whom will the client be living at their destination? *

Client's Name*

First NameLast Name

Current housing status of the client*

UnshelteredCouch surfing, doubled up/unsafe or unstable situationStaying in a shelterImminent risk of losing stable housingFleeing domestic violence or sex trafficking

Is your client already enrolled in CMIS/HMIS database?*

YesNoUnsure/ does not have access to the database

If your client is already enrolled in CMIS/HMIS please list their client ID

Does your client have a valid photo ID?*

YesNo

Desired transportation method?

AirplaneBusTrain

What is the city and state of the destination?*

What is the estimated cost of the ticket?*

When is the preferred departure date?*

Please give actual dates and times based on itinerary. Do not write "ASAP"

Client's Phone Number

Please enter a valid phone number.

Client's Email

example@example.com

Is there any additional information we should know about?

pets, medical issues, lack of valid ID, additional travelers, special accommodations, extra needs, etc.

Please upload the client's intake form*

Please upload the client's CMIS ROI*

Please upload the travel itinerary for the client*

Please sign here verifying that you have confirmation from family/friend or housing that is agreeing to house the client*

Homeward Bound Request Form