Common Ground Living
Referral Intake Form

Thank you for considering Common Ground Living as a housing resource. Please use this short form to refer someone for housing consideration.

This is not a housing application. Please share only the information needed for our team to follow up. Submitting a referral does not guarantee placement or availability.

Referral Contact

Agency / Organization *

Job Title/ Role *

Referral Contact First Name *

Referral Contact Last Name *

Referral Phone *

Referral Email *

Person Being Referred

First Name *

Last Name *

Phone *

Email *

Your Preferred Area for Housing

Current City / County or Setting

Housing Referral

How soon is housing needed?

Immediately

Within 7 days

Within 30 days

Exploring options

common.other_option

Housing preference, if known

Private Room

Shared Room

Open to Either

Not Sure

Brief reason for referral / housing need

Anything helpful for follow-up

Optional

Permission to Follow Up

I may contact you about this referral.

The person being referred has agreed to be contacted about housing.

Consent / Contact Note

Submitting this form starts a referral conversation only. Housing availability and eligibility are reviewed separately, and a referral does not guarantee placement.

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I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.