SOAR Request Form

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SOAR Request Form

To assess SOAR eligibility we are looking for basic information on:
- The presence of medical or psychiatric conditions or symptoms which would fit an SSA listing
- Must currently be in mental or physical health treatment for conditions that are expected to last more than 12 months (i.e. therapy, medication management)
-Must be an adult or child experiencing a housing crisis
-Must be unable to work and earn substantial gainful activity (SGA) (2022: $1350/month)
- Cannot have a current SSI/SSDI case pending

- Must have children in household under 18 years

If your client does not meet the above criteria, please do not continue with the referral

If you have any questions, please email Ashton Mays: amays@safehaven.org

Email *

Referring Agency *

Client's Name *

Client's Phone Number *

Where is client staying? *

What is your clients disabling condition that limits their ability to work and make SGA? *

Has the client received mental health or physical health treatment in the past? *

Yes

If yes, how long and where is the client currently being treated? Please include all treatment providers if known. *

Staff Name *

Staff Email *

Additional Comments

Send me a copy of my responses.

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