PSH Pool Submission
If the individual you are submitting to the pool is involved with other service providers, please contact those service providers before submitting this form.

If the individual you are submitting to the pool is currently in a RRH program, you must contact their Case Manager in that program before submitting this form.

Prior to submitting this form, the individual MUST be enrolled in coordinated entry, have a MACCH Coordinated entry ROI (uploaded or electronic signature), and added to the community queue, all of which is done in HMIS.

To be added to the PSH pool during HRT, this form must be submitted by 4pm on the Tuesday prior to HRT.

Be prepared to attend HRT and present why you think this individual needs PSH and answer questions about this individuals circumstances.

We will contact you if we need any additional information to complete this submission.

If you have any questions, contact Tamara Dwyer at tdwyer@endhomelessnesstoday.org

If you do not receive an email confirming your submission after submitting this form please email Tamara Dwyer at tdwyer@endhomelessnesstoday.org
Email *
Start Date of this individual's MACCH Coordinated Entry ROI *
The MACCH Coordinated Entry ROI is a separate document from the NMIS ROI and must be current for their participation in Coordinated Entry and to discuss their situation in HRT.
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DD
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Referring agency *
Contact name *
What is your role with the individual you are submitting to the PSH pool? *
HMIS client ID *
DLA-20 score
Please describe this individuals need for PSH *
Please describe their previous supportive housing attempts *
Do you have verification of this individuals chronic status? *
If the household is currently in a RRH program they must have been documented as chronically homeless per HUD definition BEFORE entering the RRH program
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