YWFC and Five Keys HomeFree COVID-19 Emergency Housing Referral Form

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Young Women’s Freedom Center (YWFC) and Five Keys are partnering on a COVID-19 Emergency Housing project as part of their larger Home Free program collaboration to provide transitional housing for formerly incarcerated, systems-involved women and transgender, gender non-conforming people who are survivors of various forms of violence, particularly those recently released. If you have a referral for the program, please submit the applicant's information via this form to help us best support you all applicants.

Email *

Applicant name *

Please check all that apply: *

This person has recently been released from a state or county facility

This person is a senior and survivor of domestic violence who served a long-term sentence

This person is a cis or trans woman or other trans person who has served a long-term sentence, is a survivor of gender-based/domestic/sexual/street-based violence or exploitation

This person is a formerly incarcerated cis or trans woman or other trans person who is a parent of minors and is currently unhoused

none of the above

Required

Where are they currently living/residing? *

Do they have children? *

Yes

If yes, how many?

What is the best contact information we can use to reach them? *

The Home Free Emergency Hotel can provide emergency supportive housing and supportive services including access to therapy, 12 step programming and more. However, the program is not a drug treatment center as we are not equipped for detox and intensive rehabilitation services. Additionally, the program is not best suited for people with histories of severe/ difficult diagnoses that have/ or require intensive and complex treatments and support. Is there any additional information we should know about the applicant's needs and capacities regarding physical/mental health, substance use treatment, access needs etc? *

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