Referral Form for OTS Staten Island

Off The Streets Staten Island is an all -volunteer organization, dedicated to helping those experiencing homelessness who have a way to pay rent going forward, and who are referred by local social services.  We focus on one person at a time. Please complete this referral form and allow 48 hours for a response. Our OTS team will contact the client directly and reach out only if needed to the referring caseworker or agency.

If you have a problem completing this form, email OTS co- Administrators at offthestreetssi@gmail.com or call 347-987-0467 & leave a message. 

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Email *
Name of Person & Agency Referring & Phone *
Name, Phone number, and Email address and any other important information we need to know about the client *
Preferred language spoken *

Family composition & children ages.

 *

Will the family reside in Staten Island?

 *
Client has a source of income and has been approved by the landlord *
*Due to the number of furnishings and household items we provide, we cannot accommodate short-term moves.  Our mission is to assist homeless families and homeless individuals who are in the process of transitioning into permanent housing where he or she will become the sole owner of all items we provide. *

Does the client have at least a 6 month to 1 year lease?
 *
Expected Move in Date (or date of recent move) *
Address of the apartment *
If your client needs financial assistance for a security deposit, provide Landlord name, address & rental property address. Please share if time is critical. (Answer No if funding is not needed). *

What are their specific needs to the best of your knowledge? 

 *
Comments/Questions

I can attest that the client being referred is currently transitioning from homelessness into permanent housing.
 *
A copy of your responses will be emailed to the address you provided.
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