Referral Form

St. Petersburg Homeless Outreach Referral

We are a trauma‑informed outreach program supporting unhoused neighbors throughout St. Petersburg. Our team believes every person’s story matters, and that homelessness is shaped by experiences and trauma that must be understood before healing can begin and stability can be found. Our work starts with listening, honoring each person’s history, and building trust through compassion and respect.
- I am a City of St. Petersburg...
  
  Other
- Name
  
  First NameLast Name
- Email
  Please enter a valid email address.
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- This referral is ONLY for individuals who are CURRENTLY unhoused in the City of St. Petersburg with a Severe and Persistent Mental Illness (SPMI).
  
  Examples of SPMI symptoms:
  
  talking or responding to things that aren't visibly present, unusual or paranoid behavior, appearing disconnected or withdrawn, unusually high energy or agitation, rapid, excessive, or unusually loud talking, impulsive/risky behavior, etc.
  
  All other referrals WILL be rejected
- Name (if known)
  
  First NameLast Name
- Gender
  
  Other
- Race/Ethnicity
- Location of Individual
  
  Description of Location
  
  Description of Location (cross streets, landmarks, nearby businesses, street address, etc.)s Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Their Exact Location (will populate location of referral)
- Have you seen this individual at this location previously?
- Please provide a brief explanation
  How many times have you seen this person there? How long have you seen them there? Have you seen them anywhere else?
- Description of Individual
- Did the individual appear to have any mobility concerns?
- List them here:
- Does this person appear to be in a mental health crisis?
- Describe your observation to the best of your ability
  For Example: Did the individual appear to be talking to themselves? Were they demonstrating verbal aggression? Was their speech coherent, linear, or logical? What are the signs of mental illness that you noticed?
- Any Additional Information/Comments:
  Ex. Why are you referring this individual? Anything additional that may helpful for our team to know
- Should be Empty:

St. Petersburg Homeless Outreach Referral