Threshold Street Outreach Referral Sheet

Threshold Street Outreach Referral Sheet

Pottawattamie County
Threshold Street Outreach Team works with individuals who are living on the streets in attempt to connect them to housing and services. Please complete the referral form, and the Outreach Team will attempt to locate the individual to assess their needs and eligibility for services.
Date

MonthDayYear
Date
Staff Name and Agency

Staff NameAgency Name
Client Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Household Type

SingleCouple with no childrenFamily with minor childrenFamily with no minor children
Location: Address, Cross Streets, Description of Area.

Street Address

Cross Streets

CityZip Code

Description of Area
How long has client been on the streets?
Brief description of what client looks like (if client is willing):
Description of Camp/Vehicle:
Any urgent needs (food/water, safety, health, etc.):
Contact Name

First NameLast Name
Contact Phone Number
Please enter a valid phone number.
INFORMATION ONLY:

The Street Outreach Team will attempt to call the client prior to going out to find them to confirm location. The goal is to try and locate the client within two business days.

The Council Bluffs Street Outreach team goes out on the following days/times:

Mon - Mobile Outreach 10am - 12pm

Tues - Council Buffs Library 10:30am - 11:30am

Mobile Outreach 4pm - 6pm

Wed - Together Inc. 1pm - 2pm

Thurs - HFS Peer Center 11am - 12pm

Mobile Outreach 1pm - 3pm

Fri - Open for follow-ups & Referrals

New Visions Homeless Services will have a Warming Center located at 1607 Ave I in Council Bluffs from January 6th - April 4th. The hours of operation are Monday - Friday from 9am - 4pm.
Should be Empty:

Threshold Street Outreach Referral Sheet

Threshold Street Outreach Team works with individuals who are living on the streets in attempt to connect them to housing and services. Please complete the referral form, and the Outreach Team will attempt to locate the individual to assess their needs and eligibility for services.