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.
- City EmployeeLaw EnforcementBusiness OwnerResidentVisitorOther
- 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.
- Name (if known)
  
  First NameLast Name
- MaleFemaleOther
- WhiteBlack or African AmericanAsianAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderHispanic or Latino
- 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)*
- YesNo
- 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*
- YesNo
- List them here:
- YesNoI'm not sure what a mental health crisis looks like
- 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?
- 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