Required fields are marked with asterisks (*)

Notice to DASH - Outcome of Offer

Use this form to notify DASH of the outcome of an offer of an RGI or modified unit vacancy.

You must notify DASH of the outcome of offers within 72 hours of receiving the referral from DASH. You must keep DASH updated if offers will take more than 72 hours.

Name of Applicant:

Name of Housing Property:

Unit # of vacancy:

Address of Vacancy:

Outcome of referral:

Denied by housing provider

Housed

Refused by applicant

Refused by applicant - did not respond or failed to provide complete forms

Other details:

Name of Housing Provider

Staff Contact Name and Title:

Email:

Telephone: