Referral to the Community Care Liaison

Referral to the Community Care Liaison

All urgent referrals will be responded to within 72 hours; all other referrals will be responded to on a first come, first serve basis.
Full Name (person seeking assistance)*
Phone Number and/or Email Address (person seeking assistance)*
Language (if other than English)
Briefly describe the need*
Please rate the urgency of the need using your discretion and the guidelines below
Urgent -

unsafe housing, homeless, or threatened with eviction; not enough food for the next 2 days; immediate risk of being abused, hurting self, or hurting others
Semi Urgent -

rent and/or utility assistance; unemployed and/or no source of income; no stable means for securing food; looking for counseling services; needs child care to maintain employment;
Not Urgent -

interested in LifeWise services; needs assistance applying for government benefits; legal counsel; help accessing medical services;
How urgent is the need?

UrgentSemi-UrgentNot Urgent
Referrer Full Name and Organization (if applicable)
Referrer Phone and/or Email (if applicable)
Should be Empty:

Please rate the urgency of the need using your discretion and the guidelines below