Resources and Homeless Referral

Community Resources Referral

Please complete this form if your family or a family that you are referring:

* Needs help applying for health insurance (Health First Colorado (formerly Medicaid) / CHP+)

* Needs access to community resources (food, clothing, counseling, etc.)

* Needs Homeless Assistance (please note that under the McKinney-Vento Act, students in any of the following situations may qualify for homeless assistance: students who are living "doubled up" with family or friends due to economic hardship; students who are living in inadequate housing that lacks proper utilities or electricity, windows or walls, or has an insect or rodent infestation; students who are living in homeless shelters; students who are living in parks or cars; students who are completely unsheltered; and students who are not living with their parent or guardian, involuntarily, due to economic hardship or family conflict)

 
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Recipient Information
If the recipient listed above is a student please specify their school.
If the recipient listed above is a student please supply their student ID number.
If the recipient listed above is a minor please supply the name of their parent or guardian.
Submitter Information
Name of the person making this referral. If the referral is made by an Adams 12 employee, please include job title and school/building.