Housing Referral Form

Please DO NOT make this referral if client is unaware of referral and if client is unaware the specific services that GEMS provides.

To complete the Housing Referral, please follow the steps below:

1. Complete entire referral from (print or type). Attach additional paper if needed.

2. Attach the following documents to the referral:

   • Proof of negative PPD text within last 6 months.

   • Completed mental health evaluations/psychosocial reports.

   • A short-written statement by the client as to why they feel that the GEMS program is appropriate for them and what they hope to accomplish/achieve while in the program.

3. Email the completed referral to victoria@gems-girls.org. You will be notified if referral is accepted or not. Staff will contact person making referral regarding net steps and/or initial appointments.