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.
Individual Requesting Referral:
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)
Either Single or Family
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
Currently in Shelter
Currently on Street
SPMI on File
None of the Above
Does your program allow for doubled up households?
Does your program require that a client reside in a specific county?
If yes, which county?
Other comments regarding your referral request:
Send me a copy of my responses.
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