Referrals – Alexti Transitional Living

Refer someone for transitional housing.

Alexti works with appropriate community partners, including reentry organizations, case managers, probation/parole professionals, shelters, churches, nonprofits, social workers, and other agencies.

Please provide enough information for an initial housing review. Do not submit Social Security numbers, bank information, or detailed medical records through the public form.

Prefer a printable form? Download PDF. Need a housing accommodation? View forms & documents.

Referral partner information

Organization *

Your Name *

Your Email *

Your Phone

Funding / Payment Source, if known

Applicant information

Applicant First Name *

Applicant Last Name *

Applicant Email

Applicant Phone

Date of Birth

Desired Move-In Date

Housing Need *

Preferred Location

Current Housing Situation

Probation / Parole Status

Expected Length of Stay

Employment / Income / Funding Information

Accessibility or Housing Accommodation Needs

Referral Notes

Additional Information

Please do not submit Social Security numbers, bank account information, passwords, or detailed medical records through this form.

I confirm that I am authorized to submit this referral and understand that submission does not guarantee placement. *