Basic Program Referral Partner Application

Thank you for your interest in becoming a Referral Partner for One House at a Time’s Beds for Kids program

We interview and select referral partners for our Basic Program on an annual basis. If your organization meets the eligibility requirements and you would like to be considered for partnership, please complete this form. Interviews will take place in October and final selection in December. Please keep in mind that organizations with an emphasis on home visits and direct housing assistance are preferred.

**IMPORTANT** Please complete the below form to request partnership with the Beds for Kids program. Once complete, we will contact you within 2 work days. Please ensure you scroll all the way to the bottom of this page and click the purple "submit" button when your request is complete. Thank you!

Organization Name

Organization Director Full Name

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Organization Zip Code

Organization Phone

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Organization Website

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Representative Full Name

Representative Phone

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Representative Email

Organization's Mission