NE CoC CES Referral Request
Use this form to submit information when requesting a referral from the Northeast Minnesota Continuum of Care Coordinated Entry Priority List.


1. Enter requested information about your referral request below.
2. Information will appear in the referral request spreadsheet and priority list manager will receive a notification.
3. Within 3 business days, the priority list manager will send you a referral via email.
4. Refer to the NE CoC CES Policies & Procedures for guidance.
Email address *
Individual Requesting Referral: *
Agency: *
Program: *
Program HMIS Provider ID (if applicable): *
Date of Program Opening *
Number of Program Vacancies (per policy, 3 referrals are sent for each vacancy as allowable) *
Type of Housing *
Household Type Requested (select all that apply) *
Number of beds available for program vacancy *
Check all that apply: This means they MUST be these categories - not that you will accept these categories *
Does your program allow for doubled up households?
Clear selection
Does your program require that a client reside in a specific county?
Clear selection
If yes, which county?
Other comments regarding your referral request:
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