OUR PROGRAM IS CURRENTLY FULL. WE KINDLY ASK YOU TO CHECK BACK WITH US ON MARCH 1, 2025, FOR ANY AVAILABILITIES OR UPDATES REGARDING ENROLLMENT. Client Name * First Name Last Name Client Date of Birth * Client Phone Number (No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.) Client Email Referring Person * Self Family Member Or Friend Waiver Case Manager CPC 2.0 Partner Referral CURA Partner Referral Jabez CLS Partner Referral Organization of Liberians Minnesota StoneBridge World School Other Referring Person's Name (if not self) First Name Last Name Have you lived in a shelter and completed a coordinated entry assessment in the past 12 months * Yes No Unsure Do you have active Medical Assistance in Minnesota * Yes No Unsure Do You Have A Housing Focused Person Centered Plan? * Yes No Unsure Do You Have A Professional Statement of Need? * Yes No Unsure Do You Have A CSSP or Care Plan * Yes No Unsure Organization/School (if applicable) Preferred Method Contact for Intake Phone Call Email Text Phone number to call or text for intake scheduling (No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.) (###-###-####) *Message and Data Rates May Apply* Email for Intake Scheduling Message Thank you! Someone from our team will contact you within 72 hours. For any other documents pertinent to this referral, please send them to referrals@lcssmn.com with the client's name as the subject. We will make three attempts to contact you via your preferred method before we close your referral.