Refer A Client To TUREM's ILH Housing Program

Use this form to refer a client for independent living placement.

Please complete all fields on behalf of your client. You'll receive a confirmation once submitted, and we'll follow up within 1-3 business days.

Today's Date *

Referral Partner Information

i.e. case manager, discharge planner, parole officer, VSO, social worker, etc

RP First Name *

RP Last Name *

RP Title/Role *

RP Organization/Agency *

RP Phone *

RP Email *

ILH - RP - Have you referred clients to us before? *

Client Information

Client First Name *

Client Last Name *

Client Phone *

If your client has a phone, we'll reach out to them directly. If not, we'll coordinate through you.

Client Date of Birth *

Used to create a unique record for your client.

Client Email

Optional

ILH - RP - Does your client have a phone or device they can be reached on? *

Housing Details

Location Preference *

ILH - RP - Move In Timeframe *

Client Eligibility

Our homes require verifiable monthly income of at least $850/month.

Please confirm before submitting.

ILH - RP - Income Source *

Select all that apply.

ILH - RP - Income Status *

ILH - RP - Monthly Income Range *

ILH - RP - Smoker *

Our homes are strictly non-smoking & non-vapor indoors & on the premises. Please answer honestly - This helps us ensure a good fit for everyone. We have a housing partner network who may can place your client, if we can't.

ILH - RP - Animals *

Our homes are strictly pet-free.

Animal Details

Please provide as much details as possible.

Additional Context

ILH - RP - How Are You Connected To This Client/Individual *

How would you prefer we coordinate on this referral? *

Additional Information

Additional Notes

By checking this box, I consent to receive non-marketing text messages from The Ultimate Real Estate Management about housing. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others from The Ultimate Real Estate Management at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.