Out-Wayne County Coordinated Entry Community Referral Form

The following referral form is for use by Out-Wayne County Community Partners who want to refer individuals/families experiencing a housing crisis in Out-Wayne County to housing resources.  Assistance from the referring partner may be needed and is suggested in completing the form. A member of the Coordinated Entry team will contact the household within 3 business days of receipt of the referral, as capacity allows.

Please note: any households residing in Detroit, Hamtramck, or Highland Park need to be serviced by Detroit's Coordinated Entry System, CAM, and will be redirected to CAM by our team if this form is completed. If the household being referred lives in one of these three cities, please contact CAM for assistance at 313-305-0311 or find out more information at CAM's website


I (head of household) give permission to the community partner to refer for services related to housing assistance through the Out-Wayne Coordinated Entry process. This may include disclosing or obtaining contact information, homeless status, and other general information needed to assist in resolving my housing crisis.