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Housing Referral Form

  1. Please DO NOT make this referral if client is unaware of referral and if she is unaware of the specific services that GEMS provides.
  2. Please complete entire referral form in print/type. Attach additional paper if needed. Please fax or mail the completed referral to GEMS, Attn: Julie Laurence,  Chief Program Officer.  You will be notified if referral is accepted or not. Staff will contact you regarding next steps and/or initial appointments.
  3. In addition to answering ALL sections below please attach the following to this referral:
    • Proof of negative PPD test within last 6 months
    • Completed mental health evaluations/psychosocial reports
    • A short written statement by the client as to why they feel that the GEMS program is appropriate for them and what they hope to accomplish/achieve while in the program.
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