Referral form: 40 Prado Housing Focused Shelter Program

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If you have questions about this form please contact the the 40 Prado Homeless Services Center:

chale@capslo.org

805-544-4004 ext. 2

The responses to these questions do not disqualify you from our services. These questions are here to allow us to meet your needs in the most efficient manner possible.

First Name *

Last Name *

Nickname *

Who is filling out this referral? *

What is the best way to contact you? *

Phone

In person

A friend of family members phone

My case manager's phone

Other:

Phone Number

(if not your phone name of person who owns this number)

If in person where are you staying currently (intersection or park name)?

Are you seeking services as an Individual or as a member of a Family with children under the age of 18? *

Individual

Family

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