CLC4 Housing Referral Form

Please note our program eligibility criteria before submitting a referral. Clients who do not meet the following will not be eligible for supportive housing services.

  1. CLC NMD-TAY Client of CLCLA
  2. 18-20 years of age
  3. 90 days prior to 21st birthday
  4. Homeless/unhoused
  5. At-risk of being homeless
  6. Recently housed and/or in transition

All financial assistance requests—including those for tangible items, furniture, or first and last month’s rent—must be referred to Housing Team and are only available to youth actively engaged in services. Funding is limited and subject to availability. Housing referrals for CLCLA 1,3,4 & 5 should be sent to CLCLA4 Housing. All CLCLA2 referrals should be submitted to CLCLA2 Housing here.

Dependency Contact Information
Referral Information
Gender
Race/Ethnicity
Check all that apply.
Please provide the following information about the young person you are referring.
Need and Characteristics
Which areas of advocacy does your client need assistance with?
Check all that apply.
What benefits is the youth receiving?
To the best of your knowledge, check all the following documents that the young person already has:
Check all that apply.
Does the youth have any behavioral issues impacting housing stability?
Is the youth linked to any specialty units?
Additional CLC Information
Conflict CLC Firms
Referral History
Indicate youth interest in the program (i.e., referral outcome)