• Agency Partnership Application

    MOU / Referral Partnership Request Form
  • Type of Organization:*

  • MOU REQUIRED BEFORE REFERRALS

    Holy Ground Homeless Outreach God Inspired Ministry welcomes professional referral partnerships with hospitals, agencies, organizations, churches, and community service providers.

    To ensure proper coordination, accountability, documentation, communication, and responsible use of available resources, an approved Memorandum of Understanding / Referral Partnership Agreement must be completed before any agency, hospital, organization, or service provider sends, directs, or refers individuals to Holy Ground.

    No client-specific referral conversation, discharge coordination, placement review, or referral processing will begin until the referring organization has an approved MOU on file with Holy Ground.

    Submitting this application does not guarantee approval as a referral partner. Submitting a client referral does not guarantee acceptance, placement, housing, residency, or immediate services.

    All individuals must complete Holy Ground’s intake, documentation, eligibility review, and case management process.

    What the MOU Will Entail

    The Memorandum of Understanding / Referral Partnership Agreement will outline the expectations, responsibilities, and referral process between Holy Ground and the approved referring organization.

    The MOU will include:

    • Purpose of the referral partnership
    • Referral procedures and communication expectations
    • Agency responsibilities before submitting referrals
    • Holy Ground’s intake and review process
    • Required client documentation and consent
    • Case management coordination
    • Eligibility and documentation requirements
    • Referral Partner Code assignment and usage
    • Partnership tier selection
    • Confidentiality and information-sharing expectations
    • No-guarantee-of-placement language
    • Terms of partnership, renewal, and termination


    The MOU is designed to protect the client, the referring organization, and Holy Ground by ensuring that referrals are handled through a clear, professional, and accountable process.

    Referral Partner Code

    Once an organization is approved and the MOU is completed, Holy Ground may issue a unique Referral Partner Code.

    This code must be used when submitting future client referrals.

    The Referral Partner Code allows Holy Ground to:

    • Confirm that the referring organization has an approved MOU
    • Identify the agency connected to the referral
    • Track referral volume and communication
    • Connect client referrals to the proper referral partner
    • Ensure referrals are submitted through the proper process

    Referral Partnership Process

    1. Organization completes the Agency Partnership Application.
    2. Holy Ground reviews the application.
    3. Holy Ground assigns a Referral Partner Code.
    4. The approved organization may submit client referrals using the assigned code.
    5. Holy Ground reviews each referral through its established intake, eligibility, documentation, and case management process.

    No agency may send, transport, direct, or refer individuals to Holy Ground before the MOU is approved.

     

  • Is the physical address the same as the maiing address*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Population Served:*

  • Important Notice

    Partnership support helps Holy Ground provide referral coordination, intake processing, case management review, documentation review, communication, and transitional service access.

    Partnership support does not purchase housing, guarantee placement, guarantee acceptance, guarantee residency, or guarantee immediate services in any Holy Ground program.

    All referrals remain subject to Holy Ground’s eligibility review, documentation requirements, program capacity, safety considerations, available resources, and case management process.

  • Partnership Tier Selection

  • How many individuals do you estimate your organization may refer?*

  • Standard Referral Partner — $1,000 per month

    Best for agencies with occasional referrals and basic coordination needs. This tier includes: Approved MOU partnership status

    • Approved MOU partnership status
    • Assigned Referral Partner Code
    • Access to Holy Ground’s agency referral process
    • Standard referral review
    • Basic documentation checklist
    • Email communication regarding submitted referrals
    • General intake coordination when available
    • Referral tracking connected to the agency code

    This tier is appropriate for organizations that need a formal referral pathway but do not require ongoing coordination meetings or high-volume referral support.

  • Coordinated Referral Partner — $2,500 per month

    Best for agencies with regular referrals and a need for stronger communication and documentation support. This tier includes everything in Tier 1, plus:

    • Priority review of properly submitted referrals
    • Scheduled monthly coordination call or virtual check-in
    • Assistance understanding Holy Ground’s intake and documentation expectations
    • Case management communication for eligible referrals
    • Support identifying missing referral documents before intake review
    • Referral status communication through the approved agency contact
    • Improved coordination for clients needing transitional services

    This tier is appropriate for organizations that frequently serve individuals who may need Holy Ground’s transitional services and require a more organized referral relationship.

  • Priority Referral Coordination Partner — $5,000 per month

    Best for hospitals, agencies, insurance companies and organizations needing structured referral planning and leadership-level coordination.This tier includes everything in Tiers 1 and 2, plus:

    • Quarterly partnership planning meeting
    • Direct communication pathway with Holy Ground leadership or approved designee
    • Priority coordination for properly documented referrals
    • Referral trend review and communication planning
    • Support with discharge or transition coordination when appropriate and pre-approved
    • Guidance on required client documentation before referral submission
    • Agency code tracking for reporting and accountability
    • Recognition as an approved referral coordination partner, when appropriate

    This tier is appropriate for organizations that want a serious, structured partnership and a clear process before referring individuals to Holy Ground.

  • Strategic Community Impact Partner — $20,000 per year

    Best for organizations seeking a long-term partnership with expanded coordination, planning, and community impact alignment.

    This tier includes everything in Tiers 1, 2, and 3, plus:

    • Annual strategic partnership status
    • Quarterly leadership meetings
    • Expanded referral coordination planning
    • Priority communication for approved referral submissions
    • Annual partnership review
    • Community collaboration opportunities
    • Recognition as a Strategic Community Impact Partner, when appropriate
    • Support aligning referral practices with Holy Ground’s transitional service process
    • Higher-level coordination for agencies with consistent referral needs

    This tier is appropriate for hospitals, major agencies, larger organizations, and partners that want to support the work beyond individual referrals and help strengthen community response efforts.

  • Occasional Community Partner — $150 per referral

    Best for agencies with occasional referrals and basic coordination needs. 

    • Approved MOU partnership status
    • Assigned Referral Partner Code
    • Access to Holy Ground’s agency referral process
    • Standard referral review
    • Basic documentation checklist
    • Email communication regarding submitted referrals
    • General intake coordination when available
    • Referral tracking connected to the agency code


    This tier is appropriate for organizations that need a formal referral pathway but do not require ongoing coordination meetings or high-volume referral support.

     

  • Referral Partner Code Section

  • Do you currently have a Holy Ground Referral Partner Code?*

  • Agency Acknowledgment

  • Please check each box to confirm understanding:*

  • By signing below, the organization confirms that the information provided is accurate and that the organization is requesting consideration for a Referral Partnership / MOU with Holy Ground Homeless Outreach God Inspired Ministry.

  • Date*
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  • Should be Empty: