REFERRAL

Dwell House partners with local agencies to transform empty houses into fully furnished homes for individuals and families transitioning out of homelessness or housing instability.

We offer two referral options:

Full Home Referral — for families needing complete home furnishings and setup, also known as a Dwell Day.
Short Referral — for families needing select furniture or household items.

Please complete the appropriate form with as much detail as possible. Once submitted, a Dwell House team member will reach out to the family to explain our process, confirm their needs, and schedule a visit if needed.

Thank you for partnering with us to create welcoming, stable homes for those in need!

SELECT THE FORM YOU WISH TO COMPLETE:

Full Home Referral

REFERRING AGENCY INFORMATION

Agency Name

Staff Name

First Name

Last Name

Staff Phone Number

(###)

###

####

Staff Email

FAMILY CONTACT INFORMATION

Head of Household Name

First Name

Last Name

Phone Number

(###)

###

####

In what city is the home located?

HOUSEHOLD INFORMATION

Please complete the following to the best of your knowledge

Number of Adults in the Home

Number of Children in the Home

Specific Needs or Requirements

Does this family have any specific needs such as cribs, medical equipment, or accessibility requirements that you know of upfront? If so, please list them below.

HOUSING & STABILITY

Please complete the following to the best of your knowledge

In your professional opinion, do you believe the client is currently in or is entering stable housing?

Yes

No

In your professional opinion, do you believe the client has the necessary support and resources to maintain long-term stability and success?

Yes

No

Head of Household Employment Status

Current Housing Status

Please describe the client's current housing situation, including any housing programs they are enrolled in (e.g., Section 8, Rapid Rehousing, Metropolitan Housing, etc.).

Additional Support Programs

Please list any support programs the client is currently enrolled in that help with financial stability (e.g., SNAP, Medicaid, TANF, Ohio Works First, HEAP, rental assistance, or other relevant resources).

Has the family been informed about Dwell House and our process, including that we will be reaching out to them?

Yes, they understand and are expecting contact.

Yes, buy they need more details.

No, they have not been informed yet.

REFERRAL

REFERRAL

INFO@DWELLHOUSE.US
937 - 303 - 8005
Sidney, OH 45365

FURNISHING HOPE .

RESTORING DIGNITY.

REFERRAL

REFERRAL REFERRAL

INFO@DWELLHOUSE.US937 - 303 - 8005Sidney, OH 45365

FURNISHING HOPE .

RESTORING DIGNITY.

REFERRAL

INFO@DWELLHOUSE.US
937 - 303 - 8005
Sidney, OH 45365