Please complete this referral form in full. Complete referrals assist the SOAR team to better understand a potential client's eligibility. Incomplete forms will not be processed.

If you have any questions regarding SOAR referrals or general inquiries or if you need a physically fillable form, please email SOAR@headinghome.org.

Prior to submitting a SOAR referral form, please review the basic SOAR eligibility criteria.

The following 4 characteristics represent key eligibility criteria for SSA disability benefits:

Applicant has a serious mental illness or exhibits symptoms and/or has serious physical illnesses that affect their ability to work at a substantial gainful level.
The illness(es) or condition(s) have lasted or are expected to last for at least 12 months or are expected to result in death.
Individual is currently exhibiting symptoms of mental illness or has periods with worsening of symptoms that prevent sustainable employment. For example:
- Psychotic Symptoms (hallucinations, delusions, disorganized thinking/speech/behavior)
- Depressive Symptoms (decreased energy, lack of motivation, suicide attempts)
- Manic Symptoms (racing thoughts, disorganized thoughts)
- Anxious feelings (paranoia, nervousness)
- Cognitive deficits (brain injury, problems with concentration, memory, etc.)
- History of trauma (history of abuse, posttraumatic stress disorder, etc.)
For applicants with mental illness, they have marked restrictions in at least 2 of these functional areas, or extreme limitations in one area:
- Understand, remember, or apply information (memory, following instructions, solving problems, etc.)
- Interact with others (getting along with others, anger, avoidance, etc.)
- Concentrate, persist, or maintain pace (as they relate to the ability to complete tasks)
- Adapt or manage oneself (hygiene, responding to change, setting realistic goals, etc.)

SOAR Recommends

The following characteristics are not essential, but may strengthen an application:

Applicant is prescribed psychiatric medications and continues to experience symptoms and functional impairments
Applicant has obtainable medical evidence (for at least part of the past 12 months) that corroborates mental illness and medical conditions
- Limited medical evidence or large gaps in treatment is normal and acceptable for successful applications. Assess whether the:
  - Applicant's symptoms are severe enough that a one-time examination by a physician would provide clear medical evidence
  - Representative can write a Medical Summary Report that illustrates a link between the applicant's diagnoses and their symptoms and functional impairments
Applicant is not working due to medical and/or psychiatric conditions (i.e., not because they cannot find work or were laid off)
- History of failed work attempts (started and stopped employment due to diagnosed conditions)
- Long work history, but can no longer work up to SGA levels due to conditions
- Scattered work history due to conditions and other factors