Transfer - Stabilization (TLS)

LAFH LOCATION

Transfer Request - Stabilization (TLS)

The stabilization (TLS), this form is used when transferring to Short Term Stabilization. Common transfers are the following: TLS Placements, Prevention, Home Safe/APS, EHV Voucher Transfer.

Please take care to complete EACH field with the correct information.

Type of transfer requested

Case manager's first name

Case manager's last name

Case Manager's Information

Case manager's email

Case manager's phone

Case manager's agency

Participant's Information

HMIS ID

Program

Funding source

Participant's phone number

Participant's alternate phone

Participant's email

Number of adults in household

Number of children in household

Primary language

VI SPDAT Score

Full SPDAT Score

Voucher in-hand or no voucher?

Where is the participant transferring from?

Participant's first name

Participant's last name

Landlord's Contact Information

Landlord's first name

Landlord's phone

Landlord's last name

Landlord's email

House number

Street name

City

Unit type

Apartment or house?

Unit number

ZIP code

Security Deposit

Amount of arears?

Monthly rent

Anticipated move-in date

First PO submitted?

Date PO submitted

Participant exit completed?

Rental assistance tool completed?

Furniture request submitted?

Date furniture PO?

Housing voucher interest assessment completed?

Vendor

Required: attach the excel/fillable rental calculator

Note: Please do not attach a rental calculator for participants moving in with vouchers on-hand (HACLA). Since the system requires a document to be uploaded in order to submit the form, please feel free to submit any other form.

.pdf, .doc, .xls

Upload File

.pdf, .doc, .xls

Upload File

Your transfer request for RRH has been submitted.