Miracle Messages - Referral Form!
Miracle Messages reconnects people experiencing homelessness with their long lost loved ones. Please take a few minutes to fill out this form to refer a client (or yourself!), and our team of volunteer detectives will get started today.

Questions? hello@miraclemessages.org.

NOTE: Miracle Messages is ONLY accepting cases involving homeless individuals at this time.

I am a: *
Client information
Fill out this section if you are a CASEWORKER, CLIENT, or VOLUNTEER. If you are a LOVED ONE looking for your missing homeless relative, fill this out with information on yourself.
Eligibility *
In order to be eligible for Miracle Messages, the below criteria is required.
Required
Full Name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Current city and state *
In what city and state is the client currently located?
Your answer
Hometown city and state *
In what city and state did the client grow up?
Your answer
Have you experienced homelessness? If so, for how long?
Your answer
Contact information *
What is the best way to reach the client again? (phone #, email, shelter bed number, case worker) Important! Try to come up with a plan AND a backup plan for how to reach again. The best way to do this is to ask for a phone number AND a point of contact if that number doesn't work. Additionally, this is a good time to let the individual know where our kiosks are in their city, so that they can go back to a kiosk to get an update if needed. The kiosk calendar can be found at miraclemessages.org/calendar .
Your answer
Other information
Brief backstory (e.g., how/why did the client become disconnected from their loved one?)
Your answer
Loved one information
Fill out this section if you are a CASEWORKER, CLIENT, or VOLUNTEER. If you are a LOVED ONE looking for a missing homeless relative, fill this out with information on your missing homeless relative.
Full name
Include maiden names and middle names if known
Your answer
Relationship
Your answer
Date of birth or approximate age
Your answer
Last known location
if known, include full address (e.g., 123 Main Street, San Francisco, CA, 94102)
Your answer
Other previous known locations
if known, include full addresses (e.g., 123 Main Street, San Francisco, CA, 94102)
Your answer
Years disconnected
Your answer
Other information
Previous phone numbers or email addresses, ethnicity, high school, employer, etc.
Your answer
Other known relatives or friends of the loved one
Please include full name, relationship, date of birth (or approx. age) and last known location (including address if known)
Your answer
Caseworker information
Fill out this section if you are a CASEWORKER.
Full Name
Your answer
Organization
Which organization are you affiliated with?
Email
Your answer
Phone
Your answer
Volunteer information
Fill out this section if you are a VOLUNTEER.
Full Name
Your answer
Organization
If you met the client at an organization, please select it here.
Email
Your answer
Phone
Your answer
The Miracle Message
What is the client's message? *
Required
What is the client's desired outcome of the message?
Or anything else we should know. Thanks!
Your answer
Background information on the client. We want to understand the client's situation in his or her own words, so that we can address the case with sensitivity. Please ask the client the following: "how, in your own words, did you become homeless?" The client is not required to answer, but please ask.
Your answer
Background information on the relationship. We want to understand the client's situation in his or her own words, so that we can address the case with sensitivity. Please ask the client the following: "how did you lose touch?" The client is not required to answer, but please ask.
Your answer
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