“Welcoming persecuted persons from around the world into lives of freedom, hope and opportunity in Minnesota” / Refugee Supportive Housing Network (RSHN) REFERRAL
Services and Subsidies for Refugees/Asylees Facing Homelessness
Fax referrals to: 612.870.3622 For questions, call: 612.230.3212

IMPORTANT INFORMATION FOR REFERRING PARTNERS:

This is a SHORT-TERM, SHALLOW rent subsidy program intended to bridge a gap to self sufficiency, it DOES NOT provide long-term rent subsidies. Participants are expected to pay some portion of their rent from their own income AND are required to participate in case management services leading to self sufficiency and housing stability. Case management services will be provided through one of the following three agencies, also funded through this project: Minnesota Council of Churches, Episcopal Community Services, and Hmong American Partnership.

This program is not intended to be an immediate response to a crisis situation. There is a process required for review of referral and intake procedures that may take up to two weeks to complete.

Referred families/individuals should have exhausted all social/financial resources to resolve their housing crisis PRIOR to being referred to this program.

Incomplete referrals or referrals without ALL required verifications will not be accepted or kept on record.

A referral does not guarantee enrollment. Once a referral is accepted, RSHN staff will contact referred family directly within 5 working days. Final eligibility determination will be made AFTER intake with RSHN staff and AFTER all verifications have been completed.

Current information about availability of slots and fill-able referral forms are posted on-line at:

REFERRAL CHECKLIST:

ALL of the following must be submitted before an application will be accepted. Incomplete referrals or referrals submitted without appropriate verifications will be returned and must be re-submitted for consideration.

Copy of I-94 card or Green Card showing that the Individual/family arrived to the USA as refugees or were granted asylum status in the US.

Verification that the individual/family is currently homeless or will clearly face loss of housing within 30 days (Eviction notice, letter from shelter, foreclosure notice, ect…)

Verification that gross household income is at or below 30% of area median income (paystub, assistance verification, etc.)

Household size / Maximum Gross Household Income (annual) / Maximum Gross Income (Monthly)
1 / $17,600 / $1,467
2 / $20,100 / $1,675
3 / $22,650 / $1,888
4 / $25,150 / $2,096
5 / $27,150 / $2,263
6 / $29,150 / $2,429
7 / $31,200 / $2,600
8 / $33,200 / $2,767

ALL additional required verifications based on individual/family situation (as noted in referral form)

Current Household Information:

List ALL household members below (include those who are seeking placement together only):

Name / Gender / Relationship to Head
of Household / DOB / Social Security Number
Head of Household (HOH)
Country of Birth: / Date of Arrival to USA: / Date of Arrival to MN:
If living in MN less than 3 months, where did you move from and why?:
Current Address: / Phone #:
City: / Zip Code: / # of people in household:
Did you come to the US as (check one): RefugeeAsyleeother , list______
CURRENT TOTAL GROSS MONTHLY HOUSEHOLD INCOME: $______Sources of Income (Check all that apply):
SSI: $______
Work Comp $______/ MFIP: $ ______
Unemployment $______/ GA:$ ______
Food Support $______/ Family/friends $______
Other: $______
Emergency contact person: Relationship: Phone #:
Is it OK to talk to the Emergency contact person listed above about your housing situation? YES / NO
ALL QUESTIONS MUST BE ANSWERED COMPLETELY AND VERIFICATION SUBMITTED AT TIME OF REFERRAL, OR REFERRAL WILL NOT BE ACCEPTED / Circle all that apply
Questions concerning housing situation and trigger crisis:
  1. Are you currently homeless [homeless defined as living in homeless shelter, in hotel due to lack of suitable housing, in a car or on the street]? If yes, attach verification & skip to question #3.
/ Yes / No
2. Are you facing imminent loss of housing (within 30 days)? If facing imminent loss of housing, what is causing you to lose your housing?VERFICATION REQIRED WITH REFERRAL FOR ANY BOXES CHECKED. If verification is unavailable, you must provide an explanation why.
You are being evicted from your housing
You are currently living in a rental unit that is facing foreclosure
You are doubled-up with relatives or friends & are violating your host’s lease
You are living in overcrowded conditions & landlord has given a warning to reduce occupancy or be evicted
You have experienced a sudden and significant loss of income
You are the victim of domestic violence or abuse
You are currently unable to pay for existing housing costs: Total monthly rent paid $______
Total household income $______
Other (Explain) / Yes / No
Questions concerning family size, composition and other needs:
  1. Does your household consist of five or more members? If yes, how many? ______
/ Yes / No
  1. Is the head of household a single parent or currently pregnant?
/ Yes / No
  1. Is the head of household under 25 years of age, or over 65 years of age?
/ Yes / No
  1. Have you ever been sanctioned for non-compliance with MFIP work or education requirements? If so, why?
/ Yes / No
  1. Do you or any of your family members have special needs such as:
 Physical disability, chronic health condition or mental illness? If yes, please explain:
 Inability to live independently due to physical or mental disability?
 Drug or alcohol dependency for any member of the household? / Yes / No
Questions concerning resources and supports:
  1. In addition to your current income, what other financial resources do you have available to you?
Money saved
Family or friends who can help you financially
Other Assets or Supports (describe):
  1. Describe what you have already done to try to resolve your housing crisis? Include agency services you have sought out to help you resolve this situation.

  1. List agencies you are currently working with, and what services they are providing:

  1. What else do you want MCC to know about your current situation?

Signature of Prospective Participant: / Date:
Signature of Referring Staff Member: / Date:
Referring staff person name:______Organization______
Phone #______E-mail:______Fax#______

To ensure your referral can be processed, please double check to ensure you attached all the following to this referral. If any of these items are not attached, please explain why it can not be obtained.

Copy of I-94 or Green Card

Verification of income

Verification that household is homeless or at risk of becoming homeless

Additional verifications based on family situation (Many questions with YES answer REQUIRE verification). Please double check that all necessary verifications are attached.

122 Franklin Ave. W, Suite 100; Minneapolis, MN 55404

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