Request a Haven for your client:

If you are a verified Referral Partner with Homes & Havens, please fill out the form below on behalf of your client. Clients are not allowed to submit this form, only someone connected to the agency + client history can request support.

This form is considered the application process for your client, therefore we trust YOU as someone who is a witness to this woman's transformation and needs. We are looking for women who are 1) taking their recovery/new chapter seriously, 2) pursuing job/education, and 3) who have acceptable housing. To learn more about who we are looking for as a client, click here to view our Partnership Packet.

Please do not give clients our contact information, as we will directly communicate with you.

Please also note that we have a waiting list at this time. If your agency is able to provide supplemental finances to help us complete your client’s home installation, please list that below. It costs us around $5,000 to completely furnish/decorate one home. Some agencies pay this entire fee, some pay half, and some need the entire fee covered by Homes & Havens. If your agency is able to help, this potentially impacts where we place your client on the waitlist. We’d love to serve each and every client immediately, but we are a small nonprofit with a limited budget.

Thank you for understanding and we can’t wait to serve your client!


Please complete the form below

Your Name *
Your Name
Your Phone *
Your Phone
Client's Name *
Client's Name
Client Address (this information is kept secure) *
Client Address (this information is kept secure)