At PCRS, we want to support and work with you.

We provide housing services that support vulnerable people who are homeless or at risk of homelessness to maintain stable, long-term housing. We serve through street outreach, housing search, and housing-first programs. We are committed to and passionate about ending homelessness in our communities. We believe that housing is a right.

To apply for housing support please continue to the next page. The following application will ask for some basic information. After you submit this form, you can expect that someone from our team will reach to you with next steps.

Referral Information

Which region would you like to participate in our services with?

Source of Referral

Other Specify

Reason For Referral

Which program are you interested in?

The Chilliwack Housing Hub Program is currently not accepting referrals at the moment.

If you have any questions regarding the status of the program, please email housinghub@pcrs.ca.

For access to additional resources in the community, please head over to the Pathways Community Service Directory.

The Housing Hub helps residents of Chilliwack who are homeless or at risk of homelessness to acquire housing with supports in the community. The program is open to individuals, couples, and families, aged 19 and over.

You may be eligible for the Housing Hub program if you:

Have been a resident of Chilliwack for at least the last 6 months
Are currently homeless or at imminent risk of homelessness (including those in transitional housing)
Need additional support to maintain stable housing and live independently
Agree to participate in our program which includes a once a week in-home visit (at minimum), and working together with program staff to create and work towards a wellness plan and your personal goals

Referrals to this program are accepted only by third party service providers, which can include other agencies/organizations, social workers, counsellors, medical/mental health professionals, and outreach workers, amongst others. For questions or additional information, please contact us at 604-795-5994 or housinghub@pcrs.ca.

Form Type

Referral Date

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Participant Information

Name

Chosen First Name

Chosen Last Name

Legal First Name

Middle Name

Legal Last Name

Basic Information

Date of Birth

Gender

Pronoun(s)

Ethnicity

Immigration Status, if applicable

Indigenous

First Nations Band (if applicable)

Ethnicity, Other

Social Insurance Number

Language Support needed?

Contact Information

Participant Contact Information

Primary Phone Number

Alternate Phone Number

Email Address

Preferred Method of Contact

Emergency Contact Information

Name

Relationship to Participant

Phone Number

Home Address

Street 1

Street 2

City

Province

Postal Code

Referrer Contact Information

Referrer Name

Referrer Agency

Referrer Address

Referrer Phone

Referrer Email

Relationship to Participant

Is this referrer the participant's primary professional support

YesNo

Related Contacts (Select and add all that apply)

Type

Contact Name

Phone Number

Email

Agency

Criminal Justice Involvement (if applicable)

NonePastCurrentOn probation

Youth Justice Participant Information

Current Charges Outstanding

Correction Service Number

YCNRA Needs (If applicable)

YCNRA Risks (If applicable)

Urgent Needs

Urgent Services Required?

YES

Urgent Needs Explanation (e.g fleeing domestic violence)

Areas of Concern

Ongoing Needs/Concern

YES

Areas of Need Explanation

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