• Jones Housing Programs – Community Referral Form

    Jones Housing Programs – Community Referral Form

    Jones Housing Programs – Community Referral Form

  • 1️⃣ Referral Source Information Section

  • Format: (000) 000-0000.
  • Relationship to the Individual*
  • Are you referring in a professional capacity?

  • 2️⃣ Referred Individual Information

  • Format: (000) 000-0000.
  • Age
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does the individual have verifiable income?*

  • 3️⃣ Eligibility & Screening Questions

  • Is the individual able to live independently (no medication administration or 24-hour supervision required)?*
  • Is the individual currently on probation, parole, or under supervision?*
  • Is the individual willing to live in shared housing (if applicable)?*
  • Does the individual have any recent violent offenses (within the past 5 years)?*

  • 4️⃣ Additional Context

  • 5️⃣ Acknowledgment Section

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Thank you for submitting this referral.

    The referred individual must complete the full housing application for the specific program they are being referred to. Applications vary depending on the housing program.

    Primary application links:

    Jones Haven for Women:
    https://form.jotform.com/252935101060041

    Jones Haven for Women & Children: 
    https://form.jotform.com/260314691869062

     

    Jones Second Chance Housing (Men):
    https://form.jotform.com/251755659966174

    If the individual is unsure which program applies, they may complete the appropriate application and our team will review for alignment.

    Submission of this referral does not guarantee placement. All applicants are reviewed case-by-case and must meet program qualifications.

  • Should be Empty: