Haven Legacy Living

Referral Partner Interest Form

Tell us about your organization’s housing needs and explore a referral partnership. Please describe general needs only; do not include individual client information.

Fields marked * are required. Your answers are submitted to Haven Legacy Living’s private inbox. Call (470) 969-5900 for help.

Organization information

Organization / agency name *

Service area / counties

Contact person and title *

Phone *

Email *

Website

Residents you serve

Do you work with adults who can manage daily living independently, with outside support if needed?

Housing barriers or general needs

Housing needs

Preferred cities / counties

Housing needed

Private bedroom with shared common areasShared bedroomEntire home / apartmentOther

Monthly budget per resident: minimum ($)

Monthly budget per resident: maximum ($)

Preferred length of stay

How soon do clients typically need housing?

Estimated clients per month (not a commitment)

Location, transportation, or accessibility needs

Referrals and financial assistance

Interest in connecting

How would you like to connect?

Schedule an introductory conversationReceive housing availability updatesReview a proposed propertyShare the free move-in interest formDiscuss partnership after provider review

Additional questions / requirements

Completed by *

I agree that Haven Legacy Living may contact me about this inquiry. I have not included confidential client information. *

By submitting, you send these answers to Haven Legacy Living for review and follow-up. No payment is collected here. Please do not include Social Security numbers, bank account information, or medical records.

Keep this page open until you receive confirmation.

View the printable PDF version