Runaway and Homeless Youth Services (RHY) Referral Form

  • Runaway and Homeless Youth Services (RHY) Referral Form

  • Service Information

    Please read service information below for program information and eligibility

  • United Action for Youth (UAY) Runaway and Homeless Youth (RHY) Programs provide services and support to youth experiencing homelessness.

    Program Services include:

    • Street Outreach Program (SOP) 
    • Transitional Living Program (TLP)
    • Maternity Group Home (MGH)
    • Youth Prevention and Response Program(YHDP) 

    Program Eligibility:

    • Unhoused/Homeless Youth ages 12-24
      • SOP - ages 12-21
      • TLP - ages 16-22
      • MGH- ages 16-22
      • YHDP - ages 16- 24
    • Unhoused/Homelessness is defined as the condition of lacking stable, safe and functional living space/housing.  This generally includes living on the streets, moving between temporary accomodations such as family or friends, or living in sutuations with no security of tenure

    Program Services Areas: service area includes the following Counties within Iowa:

    • Cedar (MGH, SOP, TLP and YHDP)
    • Johnson (MGH, SOP, TLP and YHDP)
    • Washington (MGH, SOP, TLP and YHDP)
    • Iowa (TLP)
    • Muscatine (MGH and TLP)

    Program Services include:

    • Outreach services
    • Supportive Residential Services
    • Aftercare services
    • Coordinated case management and advocacy 
    • short-term housing and financial assistance(YHDP Only)

     

    To Complete Referral Form Click the next button below to continue

     

  • Referring Person's Information

    Please complete your information below
  • Format: (000) 000-0000.

  • Referral Information

    Please complete the information below.
  •  - -
  • Format: (000) 000-0000.

  • General Information

    Please complete the information below

  • Dependent Care Situation

  • Dependent Care Information

    Please complete information below
  •  - -

  • Additional Information

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  • RHY Program Sort Criteria

  •  - -

  • Sort Criteria

  • Thank you for taking the time to complete RHY Program Referral Form

    Please click submit button below to submit the referral.  If you need immediate

    assistance please contact the UAY Eastdale office at 319-338-7518 or

    SOP@unitedactionforyouth.org.

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