• Agency Partnership Application

    MOU / Referral Partnership Request Form

  • 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
    • A Referral Partner Code does not guarantee acceptance, placement, housing, residency, or immediate services.

    Referral Partnership Process

    1. Organization completes the Agency Partnership Application.
    2. Holy Ground reviews the application.
    3. The organization selects the appropriate partnership tier.
      If approved, Holy Ground issues the MOU / Referral Partnership Agreement.
    4. Both parties sign the MOU.
    5. Holy Ground assigns a Referral Partner Code.
    6. The approved organization may submit client referrals using the assigned code.
    7. 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 and signed.

     

  • Type of Organization:*
  • Is the physical address the same as the maiing address*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Population Served:*
  • How many individuals do you estimate your organization may refer?*

  • 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

  • Please select the partnership tier that best fits your organization’s referral needs.

  • 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*
     - -
  • Should be Empty: