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Housing Stipend Request Form

Housing Stipend Update & Payment Request

  • CLIENT, GROUP & PHASE INFO



  • HOUSING PROVIDER & PAYMENT INFO

    NOTE: We pay your residence twice per month. You request a payment for the NEXT two weeks, based on the PREVIOUS two weeks' attendance. Example: On the 25th of February, you will request payment for the first half of March based on your attendance the last two weeks of February.
  • I am requesting payment for the

  • MM slash DD slash YYYY
  • Example: GRH, Probation, Foster Care

  • ATTENDANCE STATUS

  • Eligibility period example: Payment: March 1-15th: Eligibility Period: Last 2 Full Weeks of February

  • ACKNOWLEDGEMENT OF HOUSING STIPEND TERMS

  • 1. Eligibility is determined by treatment attendance, and 2 or more weeks of inconsistent attendance may result in your becoming ineligible for the housing incentive.

    2. Missing more than two individual counseling session (of any type), may result in your becoming ineligible for the housing incentive.

    3. Deductions are made from stipend payments for missed groups that are not made up the same week.

Reach Us
  • 393 Dunlap St N, Ste 300  Saint Paul, MN 55104
  • 612.289.5656 
  • info@mncarepartner.com
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  • About Us
    • Contact
      • Staff
      • Staff Links
    • Katy’s Story
    • Our Staff
  • Programs & Services
    • Zoom Teletherapy Info & Links
    • Therapy
    • Roots Recovery
      • Roots Recovery Home
      • Roots Client Forms
    • ARMHS Services
    • CTSS Services
    • Parent Community Support Program
    • Digital Navigation Services
  • Referrals/Intake
    • Electronic Forms Library
    • Make a Referral to Mental Health Services
    • Make a Referral to Roots Recovery
    • Mental Health Intake Forms
    • Internal Referrals
  • Trainings
    • Upcoming Trainings
    • Virtual Trainings
    • Your Training Account
    • Login to Training Portal
  • Careers