INSTRUCTIONS

This page is for staff of Douglas County agencies to refer clients to PCCI for Rapid Re-Housing services. If you are someone who is currently experiencing homelessness and are in need of services, please visit our Get Help page and select the location where you stayed last night.

Agency Staff: Please include as much client information as possible.

In order to be eligible for PCCI Rapid Re-Housing services, the client must be literally homeless at the time of referral. PCCI’s HUD RRH programs do not provide prevention services at this time.

AGENCY REFERRAL FOR RAPID RE-HOUSING SERVICES

Douglas County Agencies

Agency Information

The name of your agency
Your full name
Please enter without spaces or punctuation
Your email address.

Client Information

Select the option that best matches the client's current situation.
Is the client currently fleeing or attempting to flee a domestic violence situation?
Please enter without spaces or punctuation
Leave blank if no email
Total combined gross monthly income for all adult household members. Program income limit is 50% AMI.
Veteran's HMIS ID number, if known.
If the client is not in HMIS, enter their date of birth and/or the last 4 digits of their social security number.
How many adults are in the household?
How many childre (under 18) are in the household?
Veteran's address or approximate location, details of situation, or anything that we may need to know to best assist the veteran.