Make a Comforts of Home Referral | United Way of Northeastern Minnesota

Thank you for referring your client to UWNEMN's Comforts of Home program!

This program is currently closed to in-person appointments, though we are able to pack requested items for pickup. A caseworker must pick up items on their client's behalf.

After you submit this form, our staff will contact you to arrange the next steps for your appointment.

Please check this box if your client has used the Comforts of Home program in the past.

UWNEMN's Comforts of Home program is meant to be a one-time use program.

If your client has mitigating circumstances, please contact sarah@unitedwaynemn.org to discuss further.

Case Manager Contact Information

Name

Company

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Client Information

Client Name

Number of Adults in Household

Ages of Adults in Household

Number of Children in Household

Ages of Children in House

What community will this family or individual be living in?

Please enter a rough estimate of the family or individual's yearly income:

Please describe this family or individual's crisis and why they are being referred to the Comforts of Home program.

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