Referral - Heading Home Guide

Heading Home supports individuals and families facing homelessness or at risk of losing their housing. We provide personalized case management, cross-sector advocacy and collaboration, and limited financial assistance to help eligible individuals or families obtain housing or remain stably housed

Please note: A referral doesn’t guarantee services or funding, but we’ll do everything we can to connect you with resources and provide caring, comprehensive support on your path to stable housing.

Who is eligible to receive supportive services from Heading Home?

Diversion & Prevention Program

Eligible individuals or households must be at imminent risk of homelessness

A household may be at imminent risk of homelessness if they are:

losing their primary nighttime residence within 14 days,
lacking a subsequent residence, and
lacking resources or support networks to secure permanent housing

Street Outreach Program

Eligible individuals or households must currently be experiencing unsheltered homelessness including living in places not meant for human habitation

Unsheltered homelessness means living in a place not meant for human habitation. These places include:

Vehicle
Outside
Abandoned building
Park or Alley

To be eligible for either program above, individuals or households must meet the following conditions:

Those eligible for services from either program must reside in Monroe county. If you are residing outside of Monroe County, please refer to the other resources on the Heading Home Guide.
Those eligible must demonstrate willingness to participate in case management services, including goal setting, communication, and follow-through on agreed-upon steps toward housing stability
Eligible individuals or households must be willing to provide or work toward obtaining necessary documentation, such as identification, proof of income, or housing-related documents.

Prioritization Factors and Considerations

Due to limited resources, Heading Home may prioritize households based on:

Income
Length of time homeless or imminent risk of homelessness within 14 days
Vulnerability (including health conditions, disability, or safety concerns)
Households with children
Survivors of domestic violence or individuals fleeing unsafe situations
Veterans

Please note: A referral doesn’t guarantee services or funding, but we’ll do everything we can to connect you with resources and provide caring, comprehensive support on your path to stable housing.

Heading Home supports individuals and families facing homelessness or at risk of losing their housing. We provide personalized case management, cross-sector advocacy and collaboration, and limited financial assistance to help individuals or families obtain housing or remain safely housed and stable.

This field is for validation purposes and should be left unchanged.

I have read the program eligibility and believe the referral I am about to submit aligns with the criteria required for either the Street Outreach or Diversion and Prevention program.

Is this a self referral?(Required)

Yes

If you have questions about your eligibility, please email referrals@headinghomeindiana.org for assistance.

Client self-referral

Date of referral(Required)

Name(Required)

First Last

Date of birth

Household size (include ages and number of children/dependents)(Required)

Phone Number

Enter Email Confirm Email

Address, if applicable

Street Address City ZIP / Postal Code

Are you a veteran?

Select your current housing status(Required)

Staying in a place unfit for human habitation (living in vehicle, outside, shelter, etc)

At imminent risk of homelessness

Where has your household slept most often in the last two weeks?

In an unsheltered situation (please indicate)

Tent/Outside

Vehicle

Abandoned Building

Currently living in housing, but I am (or someone in my family is) experiencing or at risk of violence due to another person making the housing unsafe

Another place without utilities and running water

Please describe the specifics of where you have slept most often in the last two weeks

Please indicate the location where your household has been most frequently sleeping (name of shelter, parking/tent location, etc.)

Please select the option that best describes your household's experience of homelessness

This is my household’s first time experiencing homelessness (new to homelessness in past 30 days).

My household has been experiencing homelessness, either on and off or continuously, for under 1 year.

My household has been experiencing homelessness, either on and off or continuously, for 1-3 years.

My household has been experiencing homelessness, either on and off or continuously, for 3 or more years.

When and where were you last stably housed?

Please select all the factors that are currently affecting your housing stability

Past evictions

Rent or utility arrears

Criminal history

Other

Please describe other factors affecting your housing stability

What is your source of income?

If you receive income through any of the above sources, how much is your expected monthly income?

Please select the factors that are currently affecting your health

I have a disabling condition that makes it hard for me to maintain safety in a homeless situation

I have a health condition that requires specialized housing types or supports

I am staying in a homeless situation that makes it difficult to meet medication needs

None of these apply

Other

Please describe other factors affecting your health

What are your personal strengths and current support systems? (Family, friends, faith groups, etc)

What else would you like for us to know about you?

Please submit any documentation that helps support or explain the current housing crisis

Max. file size: 256 MB.

Please select all of the options that best describe your risk of homelessness or housing instability

Please explain the reasons for denial

Please explain the health and safety concerns affecting your housing stability

Please describe the lease violations that are affecting your housing stability

Please describe what's causing you to be at risk of homelessness or housing instability.

When do you need to leave your current housing situation?

1-14 days

15-30 days

30+ days

I have not received a notice to vacate

Have you been homeless or at risk of homelessness before?

Please explain your prior housing crisis and when it took place

What is your source of income?

If you receive income through any of the above sources, how much is your expected monthly income?

What are your personal strengths and current support systems? (Family, friends, faith groups, etc)

What else would you like for us to know about you?

Please submit any documentation that helps support or explain the current housing crisis

Max. file size: 256 MB.

Referring someone else

Please provide the following information for yourself

Date of referral

Name

First Last

Phone Number

Enter Email Confirm Email

Please describe the relationship to the person/family you are referring:

I am a concerned community member

I am a friend or family member

I am from an community agency/organization

Please note the agency/organization you are affiliated with

Reason for referral

Please provide the following information for the person/family you are referring

Select their current housing status(Required)

The household I’m referring is staying in a place unfit for human habitation (living in vehicle, outside, shelter, etc)

At imminent risk of homelessness

Date of Referral

Name(s)

Last

First

Date of birth for the head of household

Household size (include ages and number of children/dependents)

Phone Number

Address, if applicable

Street Address City ZIP / Postal Code

Is anyone in the household a veteran?

Where has this household been sleeping?

In an unsheltered situation (please indicate)

Tent/Outside

Vehicle

Abandoned Building

Another place without utilities and running water

Please indicate the location where the household has been most frequently sleeping (name of shelter, parking/tent location, etc.)

Please describe the current sleeping location of the individual or household you are referring

Please provide a description of what the household members look like and locations they frequent.

Please select the option that best describes the household's experience of homelessness

This is the household’s first time experiencing homelessness (new to homelessness in past 30 days).

The household has been experiencing homelessness, either on and off or continuously, for under 1 year.

The household has been experiencing homelessness, either on and off or continuously, for 1-3 years.

The household has been experiencing homelessness, either on and off or continuously, for 3 or more years.

When and where was the household last stably housed?

Please select all the factors that are currently affecting their housing stability

Please describe what other factors are affecting their housing stability

What is the household’s source of income?

If they receive income through any of the above sources, how much is their expected monthly income?

Please select the factors that are currently affecting their health

They have a disabling condition that makes it hard for them to maintain safety in a homeless situation

They have a health condition that requires specialized housing types or supports

They are staying in a homeless situation that makes it difficult to meet medication needs

None of these apply

Other

Please describe what other factors are affecting their health

What other services are they currently receiving from the community or your organization?

Who or what are their current support systems? (Family, friends, faith groups, etc)

What else would you like for us to know about them?

Please submit any documentation that helps support or explain the current housing crisis

Max. file size: 256 MB.

Date of Referral

Name(s)

Last

First

Date of birth for the head of household

Household size (include ages and number of children/dependents)

Phone Number

Enter Email Confirm Email

Address

Street Address City ZIP / Postal Code

Is anyone in the household a veteran?

Please indicate the location where the household has been most frequently sleeping (name of shelter, parking/tent location, etc.)

Please select all of the options that best describe the household’s risk of homelessness or housing stability

Please describe the health and safety factors affecting their housing stability

Please Elaborate

Please describe the lease violations that are affecting their housing stability

Please describe what's causing them to be at risk of homelessness or housing instability

When do they need to leave their current housing situation?

Have they been homeless or at risk of homelessness before?

Yes

I do not know

Please explain their prior housing crisis and when it took place

What is their source of income?

If they receive income through any of the above sources, how much is their expected monthly income?

What other services are they currently receiving from the community or your organization?

What are their personal strengths and current support systems (Family, friends, faith groups, etc)

What else would you like for us to know about them?

Please submit any documentation that helps support or explain the current housing crisis

Max. file size: 256 MB.