Housing Referral Form
- Please DO NOT make this referral if client is unaware of referral and if she is unaware of the specific services that GEMS provides.
- Please complete entire referral form in print/type. Attach additional paper if needed. Please fax or mail the completed referral to GEMS, Attn: Aditee Majumdar, Residential Director. You will be notified if referral is accepted or not. Staff will contact you regarding next steps and/or initial appointments.
- 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.