HUMANITY GROUP HOMES
PARTNER & NONPROFIT ORGANIZATION CONTACT / REFERRAL FORM
Affordable • Furnished • Stable Residential Housing
Phone: 210-570-2844 Email: info@hgh.com
Thank you for your interest in partnering with Humanity Group Homes. We provide affordable furnished residential housing for adults and welcome referrals from nonprofits, case managers, social-service organizations, Veterans organizations, hospitals, workforce programs, reentry programs, and other community partners.
Important:
This is a referral/contact form, not a guarantee of placement. Availability, screening, property requirements, occupancy limits, funding requirements, and applicable laws determine whether a referral can be accepted.
1. PARTNER ORGANIZATION INFORMATION
Organization / Agency Name:
Contact Person:
First Name
Last Name
Title / Role:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Website:
Organization Type:
2. TYPES OF ADULT RESIDENTS WE MAY SERVE
Humanity Group Homes is designed to provide housing to adults age 18 and older. Referrals may include people in the following situations, subject to individual screening, property requirements, available space, and applicable program requirements:
Select all types of adult residents served:
Veterans seeking stable or affordable housing
Adults transitioning from homelessness
Adults moving from shelters or temporary housing
Adults participating in reentry programs
Adults returning to the community after incarceration
Adults aging out of foster care
Young adults needing a stable housing transition
Adults referred by case managers or social-service agencies
Adults referred by hospitals or discharge planners
Adults transitioning after a hospital or treatment stay
Adults receiving SSI or SSDI income
Adults with limited or fixed income
Adults using housing vouchers or rental assistance
Adults receiving agency or nonprofit housing assistance
Adults participating in Veteran housing assistance programs
Adults working toward employment or financial stability
Adults relocating and needing affordable furnished housing
Adults seeking a fresh start or more stable living situation
Adults connected to workforce or job-training programs
Adults referred by community, faith-based, or nonprofit organizations
3. HOUSING WE OFFER
Our housing is residential and housing-focused. Depending on the property, residents may have private or shared bedrooms and access to furnished common areas, kitchen/appliances, utilities, Wi-Fi, and other household features. Amenities and room arrangements vary by property.
Housing options offered:
Furnished residential housing
Private rooms where available
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Services Provided Directly (Section 3)
Shared rooms where available
Utilities included
Wi-Fi / Internet included
Kitchen and household appliances
Basic household supplies
Laundry where available
Heating / air conditioning
Outdoor space where available
4. SERVICES WE DO NOT PROVIDE DIRECTLY
Humanity Group Homes is primarily a housing provider. Unless a particular property or program is separately authorized and structured, Humanity Group Homes does not directly provide medical care, skilled nursing, medication administration, personal-care assistance, meals, or 24-hour clinical supervision. Residents may independently receive services from qualified third-party providers.
5. COMMUNITY CONNECTIONS WE WELCOME
Community Connections We Welcome
Case management / social services
Veterans organizations and programs
Homeless-service organizations
Hospitals / discharge planning
Reentry organizations
Foster-care transition programs
Workforce / employment programs
Job-training organizations
Transportation providers
Healthcare providers
Mental / behavioral health organizations
Food assistance organizations
Benefits / public assistance organizations
Legal aid organizations
Home-care / personal-assistance providers
Faith-based and community organizations
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6. REFERRAL INFORMATION
Please provide information about the person being referred. Do not include unnecessary medical or highly sensitive information on this form.
Referred Person's Name:
First Name
Last Name
Preferred Phone / Email:
Current Housing Situation:
Reason for Seeking Housing:
Housing Needs / Preferences:
Private room requested
Shared room acceptable
Ground-floor preference
Accessible features requested
Other / explain below
Requested Move-In Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Area / Location:
7. PAYMENT / ASSISTANCE INFORMATION
Humanity Group Homes may consider residents using private funds, SSI/SSDI income, housing vouchers, Veteran assistance, nonprofit assistance, agency assistance, or other approved funding sources. Payment arrangements are subject to program requirements and approval.
Payment / Assistance Options:
Private pay
SSI / SSDI income
Housing Choice Voucher / rental assistance
Veteran housing assistance
Nonprofit / agency assistance
Other approved assistance
Funding source not yet determined
Funding / Program Contact (if applicable):
8. REFERRAL ORGANIZATION NOTES
9. PARTNERSHIP INTEREST
Partnership Options:
I want to refer residents for housing
I want to discuss ongoing referrals
I want information about available properties
I want to discuss a community partnership
I want to receive housing availability updates
I would like Humanity Group Homes to contact our organization
Best Day / Time to Contact:
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Preferred Contact Method:
10. ACKNOWLEDGMENT
By submitting this form, the referring organization acknowledges that the information provided is intended to help Humanity Group Homes determine whether housing may be available. Placement is not guaranteed and is subject to availability, screening, property requirements, occupancy limits, funding/program requirements, and applicable law.
Referring Organization Representative:
First Name
Last Name
Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CONTACT HUMANITY GROUP HOMES
Phone:
210-570-2844
Email:
INFO@HGH.COM
Have someone who needs stable housing? Contact us to discuss availability and the referral process.
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