Jones Housing Programs Service Provider Interest Form

Jones Housing Programs Service Provider Interest Form
Complete this form about YOUR ORGANIZATION and services, not about an individual seeking housing. Do not enter a client's personal information. To refer a specific client, use the separate Jones Housing Programs provider referral process.

Please tell us about your organization, the services you offer, the populations you serve, and how you'd like to connect with Jones Housing Programs as a provider or community partner.

Note: Provider interest in partnering with Jones Housing Programs is separate from referring a prospective resident.
SECTION 1: Organization & Contact Information

Tell us about your organization, main contact, and how we can reach you.
Organization Name
Primary Contact Name

First NameLast Name
Title/Role
Email Address
example@example.com
Phone Number (Primary)
Please enter a valid phone number.Format: (000) 000-0000.
Website / Social Media (if applicable)
Which best describes your organization? (Check all that apply)

Other
SECTION 2: Organization Services & Populations Served

List your services or resources and the populations you serve.
What services or resources does your organization provide?Select all that apply.

Other
Are your services free or low-cost to clients?
Please briefly describe your organization and the services or resources you provide.
SECTION 3: Interest in Working with Jones Housing Programs

Tell us how your organization would like to work with Jones Housing Programs, including presentations or workshops.
How are you interested in connecting with Jones Housing Programs?Select all that apply.

Other
Which Jones Housing population(s) are you interested in supporting or collaborating around? Select all that apply.
SECTION 4: Housing Provider Information

Complete this section only if your organization provides housing or residential placement services. If not, select N/A where offered.
What type of housing or residential services does your organization provide? Select all that apply. If this does not apply, enter N/A.

Other
What geographic areas does your organization serve? If your organization does not provide housing or residential placement services, enter N/A.
Please provide any housing eligibility requirements, restrictions, program fees, or other important information we should know before referring someone to your program. If this does not apply, enter N/A.
Please provide your preferred housing referral contact information or referral link, if different from the contact information provided in Section 1. If this does not apply, enter N/A.
SECTION 5: Service Delivery & Collaboration

Share availability, collaboration preferences, and any additional needs.
How would you prefer to collaborate with Jones Housing Programs? Select all that apply.

Other
Do you require any documentation, a Memorandum of Understanding (MOU), or other formal agreement to collaborate with another organization? A Memorandum of Understanding (MOU) is a formal agreement that outlines the roles, responsibilities, and expectations of the organizations involved.
If yes, please explain. If not applicable, enter N/A.
How often are your services, resources, or referral opportunities available?

Other
Are you interested in scheduling a presentation or informational session with Jones Housing Programs?
Preferred dates/times and format (if yes)
What would you need from Jones Housing Programs to support this relationship or collaboration?
Is there anything else you'd like us to know?
Should be Empty:

Jones Housing Programs Service Provider Interest Form

SECTION 1: Organization & Contact Information

SECTION 2: Organization Services & Populations Served

SECTION 3: Interest in Working with Jones Housing Programs

SECTION 4: Housing Provider Information

SECTION 5: Service Delivery & Collaboration