SBC PATHWAYS TO HOUSING NETWORK
A Collaborative Housing & Shelter Resource Referral Network

Consumer Request for Referral Assistance
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The SBC Pathways to Housing Network is a service provider-driven, web-based referral system established to develop a means to more quickly and efficiently match households in San Bernardino County that are experiencing or at-risk to homelessness with available housing and shelter resource providers that best fit their needs.

The Consumer Request for Referral Assistance is designed to collect the basic household profile information needed for participating agencies to make a preliminary determination on potential options to help connect your household to available housing and shelter resources in the county. 

The SBC Pathways to Housing Network is not a service providing agency and does not directly provide any housing or shelter resources. We share consumer requests for assistance with over two dozen housing and shelter resource partners in hopes of connecting your household with available resources that meet your needs.

However, we cannot guarantee that any of our partners will have a resource to assist with your situation at this time and thus you may not receive a response to your request. We encourage you to continue to independently pursue all available options.

 
By providing your household information on the following web-based referral form, you are VOLUNTARILY CONSENTING to have the SBC Pathways to Housing Network share the information provided by you with any and all of our participating service provider partners in hopes of finding a solution to your housing situation. You are not required to respond to every question, however doing so will make it easier for us to identify all potential options for your household.

If you agree and wish to continue, please press the "I AGREE" button below.

 
Today's Date

 
First Name

 
Last Name

 
Contact Phone #

 
Gender


 
Date of Birth

 
What is your household status?


 
What is your household make-up?

 
How many adults in your household?

 
How many children under 18 years old in your household?

 
If children under 18 years old in household, what are their age(s)?

 
Do you have any pets in your household?

     
 
What is your current living situation?


 
If "literally homeless", where have you been sleeping? (car, park, abandoned property, etc.)

 
How long in your current living situation?

 
In what city or community are you currently living/sleeping in?

 
Are you willing to consider shelter or housing options outside of the area where you currently live?

     
 
Do you have a vehicle or regular form of transportation?

     
 
What is your monthly household income amount?

 
What is your source of income? (check all that apply)


 
Do you participate in the CalWorks program in SB County? (if no, skip Q21 a & b)

     
 
IF YES to CalWorks, please respond to a or b below for direct referral to TAD housing resources (info below will not be shared with other Network partners)

 
TAD Case Number

 
Social Security Number

 
Please briefly describe your current or pending housing crisis.

 
What has triggered your current or pending housing crisis?


 
Please identify your current obstacles to achieving stable housing?


 
What type of housing assistance are you seeking?


 
There are a variety of housing and shelter resources available to assist families and individuals meeting specific characteristics. To help us try and identify all potential resources that might be available to assist you with your housing crisis, please check all categories below that apply to you and/or members of your household:


 
If you are an adult without children living on a fixed income, would you like to consider housing options available through the SB County Peer Driven Room and Board Advisory Coalition?

     
 
Please provide any additional comments or information that might help with identifying referral options for your household.

 
Public School Districts offer services to households dealing with homeless and housing issues

 
Do you have children attending school in San Bernardino County?

     
 
if yes, in what school district? (or name of school and city)

 
Would you like us to share your request for assistance with school district service staff?

     
 
What agency and/or person referred you to the Pathways to Housing Network?

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