Referral Forms

If you are seeking housing or are a referrer looking for the necessary resources, please choose the correct tab below. Also available are some of the most frequently asked questions regarding our programs.

House of Charity would like to keep you updated on our openings for both our on-site supportive housing and our out-patient treatment with the option of lodging beds. Please click here to register.

For general program and intake questions not answered on this page, please contact our intake coordinator: or 612-594-2002

Day By Day Chemical & Mental Health Treatment

Day by Day Chemical Dependency and Mental Health Treatment

Day By Day is our 120-day outpatient program for women and men 18 years of age and older that offers a total quality of life approach to co-occurring Chemical and Mental Health Treatment.

To make a referral to Day by Day Co-occurring Intensive Outpatient Treatment (IOP), with the option of lodging, please fax the following documents below:

Please fax all completed information to 612-594-2030 Attn: Treatment Intake. The Intake Specialist will contact you once all the information has been received.

Instructions on how to complete the Third Party and Professional Statement of Need Forms

  • Third Party form – Please list at least 4 episodes of homelessness in the past 3 years.
    • Please exclude jail, hospital stays, treatment facilities, sober housing, and other GRH programs, etc.
    • Please list start and end dates, city, state, and the name of the facility or address.
  • Professional Statement of Need form
    • On the first page, please fill in the applicant’s information to the best of your knowledge and have the applicant sign.
    • The second page – on the top section, please check at least 1 reason, for supportive services. On the bottom section, please check at least 2 reasons.
      • A signature of the qualified licensed professional is required for this form. Please see for to determine which professional is qualified to complete this form.
Permanent Housing Supports


Single adults who have experienced long-term homeless (LTH) are placed in apartments throughout Hennepin County. Individuals must meet the state’s definition of long-term homelessness, in order to qualify for this option.
To receive a referral, please contact Hennepin County Coordinated Entry to start the process, by calling 612-879- 7624 or dial 211.
Please note: House of Charity does not accept direct referrals from the community for this option.

Housing Supports

Single adults who have experienced long-term homelessness are placed in rooms, in a community setting, with a roommate, or single room, if available. Individuals must meet the state’s definition of long term homelessness, in order to qualify for this option.

To make a referral to the GRH / permanent housing supports (lodging) please fax the following documents below:

Please fax all completed information to 612-594-2030, Attn: Admissions. The Intake Coordinator will contact you once all the information has been received.

Admissions process takes 3-5 days. If you have questions regarding the status of a submitted application, please contact the intake coordinator, at 612-594-2002.

Please note: If your client is in need of immediate shelter, please contact St. Olaf’s  Adult Shelter Connect, by calling 612-248-2350 or have your client walk-in at 215 S. 8th St. Mpls. MN   55402

Housing Supports FAQ

Programs/Housing Frequently Asked Questions

House of Charity is a Housing Supports program that provides permanent supportive housing to single adults. Residents are in a dorm like community setting and are working towards stability. Individuals must be referred by a licensed professional, such as a Counselor, Social Worker/Case manager, or Doctor, if applicable.

Please view the other tabs to download the referral forms or have your representative contact our intake line at (612) 594-2002 to request the forms to be e-mailed.

  1. What type of programs does House of Charity (HOC) offer?
    • House of Charity offers the following programs and services: Please view our brochure for more information.
  1. Is HOC a homeless shelter?
    • HOC is not a homeless shelter. However, we are a permanent supportive housing program, for single adults.
    • We provide a room, in a community setting, with Case Management Services.
  1. Where is the nearest homeless shelter?
    • Please contact St. Olaf for the nearest immediate shelter, at 612-248-2350.
      • Location: 215 S 8th St., Mpls.
  1. How do I apply for a room at House of Charity?
    • HOC must receive a referral by a licensed professional, indicating your need for supportive services.
    • You must also qualify as being long-term homeless (LTH)
      • Please assist your representative in completing a Third Party Verification Form form (or Long-term Homeless Form). Showing documented shelter stays, living on the streets, or other places not meant for human habitation.
      • Forms must be signed by your representative.
  1. How long is the approval process?
    • 3-5 business days (excluding weekends), if all needed forms are submitted.
  1. Do you have single rooms?
    • We do not hold single rooms.
  1. Do you have a wait list?
    • Typically, we have a 1-2 week wait time, in our non-busy seasons.
  1. How do I get a referral into the House of Charity?
    • You can request your Counselor, Case Manager or Doctor to refer you to HOC.
    • Please have your representative download the referral forms from our website.
      • Please visit and download the forms below.
      • Professional Statement of Need
      • GRH Pre-screen Referral Form
      • Third Party Homeless Verification
      • Combined Application Form – Only complete this application, if you DO NOT have an open financial case in Hennepin County.
  1. Do you schedule Rule 25 Assessments?
    • If you are in need of Chemical Dependency Treatment (Outpatient). Please schedule a Rule 25 OR have your completed Rule 25 faxed to 612-594-2030 to get the process started.
  1. Do you help clients get into housing, while living at HOC?
    • All residents are assigned a Case Manager who will support you with your goals, such as housing and employment resources, etc.
      • We encourage applicants to contact coordinated entry prior to entering HOC. This way, you will have more access to outside services, while residing with HOC.
    • If you are looking for apartment housing, please contact coordinated entry.
  1. What forms of payment do you accept?
    • HOC accepts Housing Support funds, Private Pay, SSI, AND RSDI.
    • Day by Day accepts Rule 25 funds, Insurance.
  1. Do you have private pay rooms?
    • Yes, the rent is $500.00 a month.
      • However, we have very limited availability for this option.
      • All general rules apply to private pay residents.
      • Resident will have a single room, if available.
  1. Do you assist with applying for funding for Housing Supports?
    • Only if you are moving into HOC.
  1. Do you assist with the application for general assistance (GA)?
    • Only if you are moving into HOC.
  1. Do accept residents with a criminal history?
    • On a case by case basis.
  1. Can I work while at HOC?
    • Please note: If you are receiving county funding. The county requires all residents to submit your paycheck stubs, once employment has started.
    • If you have income above $162 you may be required by the county to pay a small portion toward your housing costs.
  2. Can I attend school while at HOC?
    • Yes.
  1. Do you accept clients on narcotic medications?
    • We also offer medication management services.
  1. Do you provide transportation for intake?
    • Unfortunately, we do not provide transportation or bus tokens.

Resources for Walk-in Rule 25 Assessments

Facility                                                Address                                   Phone

Park Avenue Center                2318 Park Ave. N.                   612-871-7443

Avivo Inc.                          1900 Chicago Ave. S.              612- 752-8000 or 8074