Referral Form for Housing Assistance for Afghan Clients

The purpose of this form is to recommend Afghan clients for housing assistance. The client must meet the following criteria:

  • Must be from Afghanistan
  • Has a qualifying immigration status
  • Arrived in the United States on or after 7/31/21, and lives in Oregon
  • Has documentation to show their legal status and date of entry in the United States

Refugee Care Collective may be able to provide 1 month of housing, dependent on eligibility and demonstrated need.

  • This referral form is for LCSNW PC-ICM, PC-ASA, ECM, and PIP programs.
  • Please fill out this form to the best of your ability. We will not contact potential clients without contacting you first.

If you are having trouble viewing the form below, please try a different browser or email to complete the referral.

If you have not heard back within 48 hours, please email directly.


"*" indicates required fields

Please only include the full name for the head of household.
Is the client from Afghanistan?*
What is this client's immigration status?*
Please share as much information as you are able to about the individual or family's current housing situation, along with why this client needs housing assistance support.
Please write "Seeking housing" if a home hasn't been found yet.
Please share to the best of your ability. Ex: Hassan Male 39, Amina Female 37, Fatima Female 4
Priority Level:*
Please share as much information as you are able to about the individual or family.

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