Temporary Housing Application Form

Temporary Housing Application Form

Please carefully read the following instructions.

If you are a service provider seeking to make a referral on behalf of a client return to our Need Housing web page to find a copy of our Complete Referral Intake Packet.

If you are an interested applicant, please fill out the form below to begin the process of applying for temporary housing with Project PLASE.

When you have finished filling in the form, click the "Submit" button at the bottom of the page.

• Intake Checklist: The following documents, if applicable, may be needed to complete your intake process:
  Verification of mental health diagnosis and any medication prescribed
• Verification of enrollment if in an outpatient drug treatment program
• Copy of most recent lab work verifying HIV status with cd4 and viral load counts (signed by MD, RN, or LCSW)

**Please be informed, we fill all open beds from our waitlist as they become available.

Due to the nature of our program, it is impossible to predict when bed space will become available. Depending on which funding you are eligible for and the rate at which our beds are opening, the wait time may vary from weeks to months.

**In order to remain eligible and stay active on our waiting list, it is expected that applicants follow up with intake staff on the first of each month. If no contact has been made over a three-month span, applications will become inactive.