Reign of Hope-Referral Form
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  • Reign of Hope

    SERVING WITH PURPOSE RESTORING WITH FAITH

  • REFERRAL PARTNER INFORMATION & FORMS

  • This packet contains referral requirements, eligibility standards, and referral forms for partner organizations.
  • CONFIDENTIALITY NOTICE
    This document contains confidential information intended solely for referral and
    housing placement purposes. Unauthorized disclosure is prohibited.
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  • SECTION 1: PROGRAM OVERVIEW

  • About Reign of Hope Independent Living

  • Reign of Hope Independent Living is a structured, non-clinical transitional housing program for adults who are able to live independently and are transitioning from homelessness or housing instability.
  • The program provides a stable housing environment while participants work toward long-term independence, self-sufficiency, and housing stability. UReign of Hope operates with clear expectations, accountability, and collaboration with referral partners.

  • Program Model

    • Independent living housing (non-clinical)
    • Structured rules and expectations
    • Regular check-ins and accountability
    • Focus on housing stability and self-sufficiency
    • Referral-based placement only

  • What This Program IS

    • Transitional housing
    • Independent living environment
    • Supportive but non-clinical
    • Structured accountability
    • Referral-based placement

  • What This Program IS NOT

    • Emergency shelter
    • Medical facility
    • Mental health treatment center
    • Detox or inpatient program
    • 24-hour supervised housing
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  • SECTION 2: ELIGIBILITY CRITERIA

  • Individuals referred must meet the following criteria:

    • 18 years of age or older
    • Able to live independently
    • Able to manage personal hygiene and daily living tasks
    • Does NOT require medical supervision or clinical care
    • Willing to follow house rules and program expectations
    • Not actively violent or a safety risk to others
    • Willing to participate in basic program check-ins

  • Failure to meet these criteria may result in denial or deferral.

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  • SECTION 3: REFERRAL PROCESS

  • All referrals must follow the process outlined below to ensure
    appropriate placement and program fit.
    • Referral partner reviews eligibility criteria
    • Referral forms are completed and submitted
    • Pre-admission screening is conducted
    • Acceptance, waitlist, or denial decision issued
    • Approved clients complete full intake prior to move-in
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  • SECTION 4: REQUIRED REFERRAL FORMS

  • The following forms must be submitted for referral consideration:

    • Referral Cover Sheet
    • Referral Intake Summary
    • Pre-Admission Eligibility Screening
    • Release of Information (ROI), if applicable

  • Incomplete submissions may delay processing.

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  • REFERRAL COVER SHEET

    Form ROH-IL-100

  • Referral Information

  • Client Information

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  • Authorization

  • I certify that the information provided is accurate to the best of my knowledge.
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  • REFERRAL COVER SHEET

    Form ROH-IL-200

  • Client Information

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  • Gender

  • Current Living Situation:

  • Independence Level:

  • Known Barriers:

  • Client Awareness

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  • PRE-ADMISSION ELIGIBILITY SCREENING

    Form ROH-IL-300
  • Please indicate the following based on your assessment:
  • Please indicate the following based on your assessment:
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  • RELEASE OF INFORMATION (ROI) - PARTNER USE
    Form ROH-IL-400
  • I authorize Reign of Hope Independent Living to communicate with the referring organization listed above regarding my referral, eligibility, and program participation.
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