Referral for Homeless Outreach Services

**Please note this is NOT a form for self-referral. If you, your family, or someone you know well is experiencing homelessness, please call the Urban Ministry Center main line at 704-347-0278 or visit us at 945 North College Street; Charlotte, NC 28206.**
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    We are requesting the following information in case we need to follow up with you about your referral.

    We will not expose your information unless you specify that you'd like us to do so. You can expect a personal email within 2 business days of form submission to verify we received your submission, but in order to protect confidentiality, we will likely be unable to provide more information about our interaction with the individual.
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