HOPE-Parent Enrichment Referral
SPECIAL NOTE TO THE REFERRING AGENCY: Please fill this form out to the best of your ability. A representative of the HOME program will contact the client to conduct an interview and obtain a list of needs. A pick up appointment will then be scheduled within one business day in most cases. Please do not send the client to the center with a written referral. If it is an emergency that must be taken care of in a timely manner, please call the office. (810) 667-00555

Parenting Lessons and Enrichment Classes are available to women who:
-Have a child under the age of 3
-Living in Lapeer County
-Are in danger of losing custody of their child
-Have a referral from an outside agency or court
-Can produce a valid photo ID
-Have internet access.
-Have a cell phone or computer capable of playing videos.
More than 150 parenting/character building and practical homemaking topics will be made available free of charge to clients who can complete a scheduled in office intake. No more than 5 lessons may be sent at one time and new lessons may not be requested until the previous lessons have been completed. Clients will complete a pre and post test with each parenting lesson and will be allowed up to 14 days to complete the lesson. New lessons can be requested only by calling the office. New lesson requests will be granted with in 2 business days. Parent lesson activity reports may be requested by the client only and printed for pick up with a 72 hour request.

Community Material Aid is available to women who are:
-Pregnant or have a child under the age of 3
-Have legal custody of the child
-Living in Lapeer County
-Have a referral from an outside agency
-Can produce a valid photo ID
Emergency/community aid is almost always granted to clients who meet the criteria. After the initial referral, material aid pick up may be available once every six months while the referred child is under the age of 3. Baby clothing is available up to size 4T. Cribs and car seats are not available through this program. Other gently used baby equipment and baby items are subject to availability.  All items must be signed for. No parenting education or mentoring is available in this program.

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Email *
Today's Date *
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Referring Agency *
Referring Party's Name *
 Referring Party's Phone Number *
Client's Full Name *
Client's Phone Number *
Marital Status *
Is the client pregnant? *
Child/ children's gender and age *
Living Situation *
Are the client's child/children living with her currently? If not, who do they reside with? *
Is there a court order in place for parenting classes or material support? *
Has the client been convicted of a violent crime? *
Does the client struggle with mental illness?
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Does the client use illegal substances or alcohol on a regular basis? *
What are you requesting? *
Required
If web-based parenting lessons: does the client have the following *
Required
If Material Aid: Is this an emergency need? For instance is the client completely out of formula or diapers? *
If client has custody of a child under age 3, please list material aid items that are needed. *
Do you know if the client has need for an options consultation, pregnancy confirmation or viability ultrasound? *
Is there anything else we should know before contacting the client? *
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