Homeward Bound 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 HMIS. If your client wishes to remain anonymous in HMIS, please note that.
Once a request is submitted, the request will be approved or denied. All approved requests will collect on a waitlist for a week before a ticket is purchased in order to responsibly manage funds.
The client will only be allowed to check one bag covered by Homeward Bound. All pets must be service animals if traveling by plane, train, or bus. All animals costs will have a cap. After this cap, the client will need to cover the rest.
All food costs will be adjusted per meal. For example, breakfast will be $10, lunch $15, and dinner $20. A client is allocated three meals a day depending on how long the travel is. The case manager will need to measure out how many meals the client will be receiving. Once a gift card is loaded with food costs, the client will need to verbally agree that they will send receipts to the case manager or the FA. The FA will need to approve all extra costs associated. The case manager should be listing out all extra costs in a word document or other attatchment.
Lastly, all documentation will be linked with a blank form to upload. The forms attatched must be filled out and uploaded. The minimum documentation required is the HMIS ROI, the Homeward Bound intake, and the jotform intake. All documentation must be consistent with the exception of the cost break down and the screenshot of confirmation from family or friend.
All participants must sign a responsibility and rights form acknowledging the program guidelines.

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?*

Contact Information for the person stated above

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

Desired transportation method?

PlaneTrainBus

Does your client have a valid photo ID?

YesNo

You have selected plane as the desired transportation method please note that per government regulations, individuals cannot board commercial flights without a Real ID. Please confirm that your client has a Real ID.

Yes, your client has a Real ID to flyNo, please select a different travel method

City and State of their destination*

Street Address

Street Address Line 2

CityState / Province

What is the estimated cost of the ticket?

When is the preferred departure date?*

Date

Hour MinutesAM/PM Option

Client's Phone Number

Please enter a valid phone number.

Client's Email Address

example@example.com

Is there any additional information that we should know about the client?

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*

* If you have not completed a CMIS ROI, please use this link to fill out a CMIS ROI and attach it above.

Please upload confirmation of the client's stable housing upon arrival *

This can be a letter, email or other forms of communication that state the client will have stable housing indefinitely

Please note that per government regulations, individuals cannot board commercial flights without a Real ID. Please confirm that your client has a Real ID.

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

Homeward Bound Request Form

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.