Start Receiving Referrals

Does your organization provide housing for survivors of human trafficking?

Then we would love to add you to our referral database!

To start receiving referrals with us, please fill out the form below.
Once the form is submitted, we will reach out to have an orientation
meeting with you about what to expect when received referrals.

Thank you for your commitment to providing services for survivors of human trafficking!

PLEASE READ BEFORE STARTING!

If your program has multiple stages to which a new survivor can be admitted, including:

Different types of programs
Different site locations
Different demographics served

You will need to fill out the form multiple times, once for each in order to indicate different intake requirements.

Questions? Email us! Referral@shelteredalliance.org.

THANK YOU!

Program Verification

Organization Name(Required)

Your Name(Required)

First Last

Title/Position(Required)

Email(Required)

Phone Number(Required)

This is for internal use only, should we need to contact you about your program information.

What type of program does your organization offer?(Required)

Is your program currently open and serving survivors?(Required)

Is there a date on which you anticipate resuming/starting intake to your program?(Required)

What is the bed capacity of your program?(Required)

Is your program willing and able to receive referrals from ARS at this time?(Required)

Where is the city and state of your program located?(Required)

City State / Province / Region

Please list ALL email addresses to which referrals should be sent, separated by a comma(Required)

Program Criteria

What type of trafficking victim(s) does your program serve?(Required)

Our program is able to serve:(Required)

Female

Male

Non-binary (does not identify as exclusively a man or a woman)

Transgender male (a man who was assigned female at birth)

Transgender female (a woman who was assigned male at birth)

Two-Spirit (masculine and feminine spirit)

Our program is able to serve:(Required)

US Citizens

Documented Foreign Nationals

Undocumented Foreign Nationals

What is the age range your program serves?(Required)

Ex. 18+, 18-30, all ages

Does your program accept survivors who are:(Required)

How many children and what ages?(Required)

i.e. "2 children ages 0-4"

Do you accept clients from out-of-state who will need to relocate?(Required)

Please describe the level of sobriety you require new survivors to have:(Required)

Do you include alcohol and marijuana use in the sobriety policy mentioned above?(Required)

Program Information

Is your program religious affiliated?(Required)

What type of options does your program offer?(Required)

What level of supervision do clients in your program receive?(Required)

What are your program's housing arrangements?(Required)

Does your program provide any special consideration for clients of a particular minority group or underserved population?(Required)

What minority groups and what are the special considerations?(Required)

i.e. demographic given reserved bed, priority admission, scholarship, etc.

Does your service allow individuals with:

Please list the language services your program is able to provide:(Required)

Can your program accommodate residents with an service or emotional support animal?(Required)

What type of support animals do you allow?(Required)

Please list any prescribed medications that are not approved by your program:(Required)

i.e. Suboxone

Is your program able to serve individuals with severe mental health diagnosis(es)?(Required)

i.e.. schizoaffective disorders

What are the specific diagnosis(es) you are unable to serve?(Required)

What physical disabilities and/or severe learning disabilities are you able to accommodate, if any?(Required)

i.e. deafness, blindness, mobility issues, severe autism, chronic condition, etc.

What survivor services are available and provided at your organization? Mark all that apply.(Required)

National Trafficking Sheltered Alliance

672 Old Mill Rd. #123

Millersville, MD 21108

The National Trafficking Sheltered Alliance is a qualified 501(c)3 organization. All donations are tax deductible to the full extent of the law. EIN 84-2962806

Start Receiving Referrals

Does your organization provide housing for survivors of human trafficking?

Then we would love to add you to our referral database!

Program Verification

Program Criteria

Program Information

General

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