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Transitional Services Referral Form

Individuals are eligible if they meet the following criteria:

OCS Transitional Services Provision:

**Please fill out ALL following sections **

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Referral Contact Information

Previous Placement/Address

Unit Size Moving Out Of

Storage Facility


New Home/Placement

New Address
Unit Size Moving to

Security Deposit/Application Fee

Do we need to send a letter of guarantee?
Check Mailing Address

Moving Expense

Not to Exceed $1,700 of the allowable $3,000
Move Personal Items from previous home, facility or storage unit
One-time pest and allergen treatment of home
Blinds or window coverings

Preference of Essential Furniture

Not to exceed $1,000 of the allowable $3,000 *Allotted budget does NOT allow to get all items listed *Dinning set with chairs are low in stock and maybe subject to delayed arrival or availability
Furniture For Moving
Are you okay with used items?
Bed Pieces
Dining Table

Preference of Household Supplies

Not to exceed $300 of the allowable $3,000. This $300 budget does not allow for all the following items:
Cleaning Supplies

Cancellation and Weather Release Notice

Opportunity Community Services reserves the right to reschedule, postpone or delay the Transitional Services due to unforeseen circumstances (staff illness/emergency, equipment issues, client illness/hospitalization, etc.) We will take every measure to prevent these barriers from effecting the move day before making a final decision.
Opportunity Community Services will not move or deliver under these weather conditions in the county of pick up or drop off: tornado warning, severe thunderstorm warning, temperature below -10 degrees, blizzard, and white out conditions. If the move is canceled due to weather, OCS will work with your case managers to set up a new move date. OCS will not be responsible for any extra fees that may occur because of this cancelation.
Opportunity Community Services can move/deliver in weather conditions (rain, snow, sleet, etc.) with your consent. I understand that OCS is not responsible for the items getting damaged or wet due to this weather. OCS does not provide items to cover belongings being moved or protect them from the above weather conditions.
Person Served Signature
By signing above, you are acknowledging that you understand and agree to the cancellation and weather policies
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Waiver Case Manager Signature
By signing above, you are acknowledging that you understand and agree to the cancellation and weather policies
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Transitional Services Move Agreement

I consent to the following: Purchase of the items in this referral will be made through my transitional services funding. I understand the assigned OCS transitional services coordinator will be shopping on my behalf based on the selections in this referral. I understand that OCS uses specific vendors for furniture and household items, and will not purchase furniture or household items outside of those vendors (Hotel Liquidators, Walmart, and Amazon). OCS cannot purchase any electronics per DHS. OCS does not reimburse for any payments made by the client or dispose of any of the client’s personal belongings. All sales are final. OCS is not responsible for replacing or returning broken or defective items that are purchased. Original receipts will not be provided after purchase. You have 3 days post move to report any damage to your personal belongings during the move (only applicable for inside movers). If outside movers are hired you will need to work directly with them to resolve damages to personal belongings. Your case will be billed and closed out 4 days post move. After claim submission to DHS, no cases will be reopened for additional purchases.
Person Served Signature
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Waiver Case Manager Signature
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