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Need Help?
In Case of Emergency:
Harford Co. Mobile Crisis
410.638.5248
Youth Crisis Hotline: 1.800.422.0009 or
Go to the nearest emergency
room or call 911
Frequently Requested Forms
E-mail to appropriate staff member or fax: 410-803-8732
Please attach a letter with agency letterhead for Homeless I.D. Project applications
- Application for Residential Rehabilitation Services, PDF
- Application for Residential Rehabilitation Services, Word
- Application for Specialized Transitional-age Youth (TAY) Services
- Case Management Referral Form
- Child & Adolescent Care Coordination Referral Form
- Consumer Support Funds Application Form
- Homeless I.D. Project Application Form
- Homeless I.D. Project Verification Form
- Lab/Med Request Form
- Documentation for Uninsured Benefit
- Provider Request to CSA for Urgent Care for Uninsured Form 1 of 2
- Request for Reimbursement for non-Medicaid OP Services Form 2 of 2
- Respite Referral Form