Vehicle Flex Funding Waitlist Form

Vehicle Flex Funding Waitlist Form
Overview:
Home More Network (HMN) is here to assist clients relocating from Juniper Ridge and China Hat who need towing services or vehicle repairs. Please fill out this waitlist request form to let us know how we can help. We appreciate your patience as we work to address your needs within our funding guidelines and upcoming relocation deadlines.

Important Notes:
- Due to the high number of clients relocating from China Hat and Juniper Ridge around the same time, we may not be able to fulfill all requests if our staffing capacity, funding or time is limited.
- If you are within one month of your relocation date, we strongly encourage you to seek backup options, especially at China Hat. Consider reaching out to friends or family for assistance, or consult your current case manager at HMN or other local organizations including:
  - COVO
  - REACH
  - SHARE
  - Deschutes County Behavioral Health HOST Team
  - Thrive Central Oregon
  - NeighborImpact
  - Churches or other nonprofit or church service providers.
Key Dates:
- China Hat: Relocation deadline is May 1st, 2025
- Juniper Ridge (East of the Railroad Tracks): Relocation deadline is May 31st, 2025
Collaboration with Other Organizations:
While Home More Network is the primary nonprofit addressing vehicle needs, we collaborate with various businesses, nonprofits, and churches that may also provide assistance when needed.

Client Registration:
- If you are not registered as a client with Home More Network: Please register using the link on the "Thank You" page after submitting this request. Registration helps us understand your needs and connect you with local resources in Central Oregon.
- If you are already registered and your contact information or major details have changed: Please submit a new registration form.
- If your contact information has not changed: There’s no need to submit a new registration form.
Contact Us:
Email: info@homemorenetwork.org
Hours: Monday - Friday, 10 AM - 5 PM
Closed: Saturday, Sunday

Thank you for your understanding and cooperation as we work to support you in the best way possible. We appreciate your patience as we navigate each request within our community. If we are unable to assist directly, we will provide recommendations for other service providers.

CLIENT REQUEST OR REFERRAL
I am..*
If established with HMN, your case manager's first name
Service Provider Name

First NameLast Name
Service Provider Email
example@example.com
Service Provider Phone Number
Please enter a valid phone number.

CLIENT INFO
Legal Name*

First NameLast Name
Preferred Name/Alias

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

VEHICLE INFO
Current Vehicle Location:*

China Hat - Horse ButteChina Hat - Knott Road to Bessie ButteJuniper Ridge - East of Railroad TracksJuniper Ridge - TSSAWithin Bend City LimitsOutside of Bend city limits within Deschutes County
What is the vehicle?*
If "OTHER" vehicle, what is it? (School Bus, Ambulance, etc)
Vehicle Year*
Vehicle Make*
Vehicle Model*
Vehicle Color(s)*

THE REQUEST(S)
Level of Urgency: 1) Okay for HMN to respond in 14+ days, 2) Need is approaching urgency within 14 days, 3) Need requires a response or action in within 7 days.

1

2

3

1 is Not Urgent, 3 is Urgent
In need of vehicle, RV, trailer...*
If needing a repair, please explain.
If needing to relocate, please explain where this is being towed to. If an address is available, please include. *We are not able to relocate vehicles from encampments to city or residential streets.
Do you have an active Driver's License?
Do you need help getting a Driver's License?
Is this vehicle title in your name?
If the vehicle title is not in your name, do you have a Bill of Sale in your name?
Is the registration active or expired?
Do you need help to cover DMV registration fees?
Do you have active car insurance for this vehicle?
Do you need help to cover costs to start a car insurance policy?

ADDITIONAL INFO
HMIS: We honor your privacy. Home More Network has an obligation under funding guidelines to keep track of our vehicle related services in HMIS. This is also needed for anyone seeking referrals for longer term shleter, village or rental assistance programs in Central Oregon. Do you agree to be added to HMIS (Homeless Management Information System)?
From HUD's website: https://www.hudexchange.info/programs/hmis/ HMIS is a local information technology system used to collect client-level data and data on the provision of housing and services to individuals and families at risk of and experiencing homelessness. Each CoC is responsible for selecting an HMIS software solution that complies with HUD's data collection, management, and reporting standards.
Release of Information: By typing my name, I give Home More Network permission to share this request form directly and/or necessary information contained in this form with local tow companies, and/or mechanics to meet this need. I also give HMN permission to share the information in this form with nonprofit service providers or churches that may be able to meet this need if Home More Network is unable to. I understand that Home More Network is doing what they can to help as many people as possible in a limited amount of time. I agree to do everything I can to cooperate and prepare for my vehicle being relocated or repaired.

First NameLast Name
Should be Empty:

Vehicle Flex Funding Waitlist Form

CLIENT REQUEST OR REFERRAL

CLIENT INFO

VEHICLE INFO

THE REQUEST(S)

ADDITIONAL INFO