NMD‑THP Referral Form

Purpose:This form is designed for case managers, community partners, and advocates to refer young adults (ages 18–21) to our Transitional Housing Program for Nonminor Dependents (THP‑NMD). By completing this referral, you help us assess eligibility and initiate contact with the applicant.

Program Overview:Our THP‑NMD program offers more than just a roof—it provides safe, stable housing along with wraparound support. Services include:

• Life skills training (budgeting, cooking, transportation)

• Financial literacy education

• Employment assistance and job readiness

• Access to educational and vocational resources

Our goal is to partner with youth and empower them to confidently transition into independent adulthood.

Referring Agency & Case Manager

Who is referring the youth?

Youth Demographics

Basic applicant info.

Foster Care & Eligibility Summary

Confirm foster care status and initial eligibility.

Referrer's Notes

Additional context or case needs.

Consent to Share

Please Read: Before submitting this referral, please ensure that the youth (Non-Minor Dependent) has given permission to share their personal information for the purpose of connecting them with our Transitional Housing Program (THP) services. If you are the youth completing this form, your submission will serve as your consent. If you are a community partner or referring party, please confirm that you have received the youth's consent to share their information.