Partner Referral

Submit a Referral

For case managers, social workers, hospitals, shelters, reentry programs, veterans organizations, and community partners.

Referral Partner Information

1. Referral Partner Information

Organization Name *Contact Person *Job Title Phone Number *Email Address *Organization Type *

Client Information

2. Client Information

Client First Name *Client Last Initial *Age *Gender

Current Housing Situation

3. Current Housing Situation

Select all that apply.

ShelterHospitalTransitional HousingReentry ProgramFamily / FriendsHomelessOwn ResidenceOther

Desired Housing

4. Desired Housing

Room Type *Move-In Timeline *

Funding Source

5. Funding Source

Select all that apply.

SSISSDIEmployment IncomeSelf PayVA BenefitsAgency FundingGovernment AssistancePensionOther

Monthly Income (USD, optional)

Eligibility Screening

6. Eligibility Screening

Referral partner must confirm all of the following apply to the client.

Client is 18 years or olderClient can live independently without 24-hour supervisionClient agrees to a drug-free environmentClient agrees to an alcohol-free environmentClient agrees to a weapon-free environmentClient understands this is shared independent living housingClient is willing to follow house rules

Safety & Clinical Screening

7. Safety & Clinical Screening

Does client require 24-hour supervision? *

Does client require skilled nursing care? *

Does client require personal care assistance? *

Does client require medication administration? *

Are there behavioral or safety concerns we should be aware of? *

Additional Notes

8. Additional Notes

Notes

Before Submitting

A Better You Homes provides:

• Safe structured housing
• Drug-free environment
• Alcohol-free environment
• Weapon-free environment
• Independent living only (no medical or personal care services)

I certify the information provided is accurate to the best of my knowledge. *

A Better You Homes

Independent living shared housing. We do not provide medical care, personal care services, or clinical treatment.

Contact

Owner: Jatoya Williams

info@beingabetteryou.org +1 (754) 715-9420

Referrals

Case managers, hospitals, shelters, reentry programs, and community partners.

Submit a referral →