Request Emergency Housing Review

This assessment is for individuals experiencing homelessness, unsafe living conditions, or an immediate housing crisis. GriffinHearts will use this information to review emergency housing urgency, safety concerns, income status, documentation needs, and whether temporary placement may be possible pending full intake review.

SPONSORSHIP HOUSING ASSESSMENT

Please complete the following assessment to help GriffinHearts determine emergency housing eligibility, immediate safety needs, and placement readiness.

REFERRAL INFORMATION

Name of Person Completing This Referral

Organization / Agency Name

Relationship to Participant

Please provide details of your relationship to the participant:

Referral Contact Phone Number

Referral Contact Email Address

PARTICIPANT INFORMATION

Participant Full Legal Name *

Date of birth

Participant's Gender

Participant Phone Number

Participant Email Address

SPONSORSHIP/THIRD-PARTY SUPPORT

Phone Number:

ACKNOWLEDGEMENT

By submitting this Sponsorship Housing Program Assessment, I acknowledge that the information provided is true and accurate to the best of my knowledge regarding the individual being referred for sponsorship housing assistance. I understand that submission of this assessment does not guarantee placement or approval into the program. I understand that GriffinHearts Transitional Housing maintains a structured housing environment with program expectations, behavioral standards, and participation requirements, and that all placement decisions are subject to program review and approval.

Name

Signature

Clear

Date Signed

Confidential • Professional Review • Structured Process

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Contact:

+1 980-998-2985
[email protected]

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SPONSORSHIP HOUSING ASSESSMENT

Please complete the following assessment to help GriffinHearts determine emergency housing eligibility, immediate safety needs, and placement readiness.

REFERRAL INFORMATION

PARTICIPANT INFORMATION

SPONSORSHIP/THIRD-PARTY SUPPORT

CURRENT HOUSING SITUATION

HOUSING URGENCY LEVEL

SAFETY & STABILITY REVIEW

EMPLOYMENT & INCOME

EMERCENCY PLACEMENT ELIGIBILIY REVIEW

ACKNOWLEDGEMENT