To schedule an appointment for your client to receive furniture and household items, please provide us with the information requested below.
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Transportation Information Fields marked with an * are required.
STEP 1: Transportation Planning
You and your client are responsible for transporting the goods and furniture from Household Goods. Before completing and submitting the referral, confirm that your client has a reliable way of getting furniture from Household Goods in Acton into their home. Does your client have a reliable way to transport furniture and other items from Household Goods in Acton into their home?* Is your client furnishing an empty or nearly empty apartment/home?* Does your client only need one or two items to finish furnishing their home?* For example, only beds
How will the client transport their items to their home?* We strongly encourage renting a closed box truck. A 15 foot box truck is recommended for most clients. If your client plans to use a pickup truck, trailer, or roof rack which require securing loose items, your client will need to load and secure the items without the assistance of our volunteers.
Who will pay for the truck rental?* A licensed driver to drive the truck is available from:* A credit card to reserve and schedule the truck rental is available from:* Who will unload the vehicle at the client's home?*
Household Goods Application for Transportation Assistance
The purpose of the Transportation Assistance Program is to reach vulnerable people living in empty homes who would not be able to receive services from Household Goods without assistance from this program.
What is the application approval process? What transportation assistance might be available? Who is eligible for transportation assistance? and
- Have exhausted all of their other transportation options and
- Have someone at their referring agency committed to and responsible for working closely with them to ensure that they can complete their appointments. Based on the above, does your client meet the eligibility criteria? Hidden
Agency Information Fields marked with an * are required.
If you do not receive an email from us within 24-48 hours, please contact us at refer@householdgoods.org to ask if we received your referral request.
When your form is completed properly and submitted to Household Goods, you will see a Success message.
Note that this is not confirmation of an appointment, only a copy of the information you submitted.
Step 2: Agency Information Once submitted, your application for support will be reviewed by our team. If you have any questions or do not receive an email from us within 24-48 hours, please email transportassist@householdgoods.org.
When your form is completed properly and submitted to Household Goods, you will see a Success message.
Step 2: Agency Information Your Name (Agency Contact)*
First
Last
Your Agency Address* Please provide street, city, zip code
Your Email (Agency contact)* Have you changed agencies?* If you've previously submitted client referral requests through a different agency, please check "Yes" below.
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Client Information Fields marked with an * are required.
Step 3: Client Information Client Address* Address of home/apartment being furnished
What floor does your client live on?* Client Email Address **We collect this info in order to send clients an appointment reminder email and for 'remote zoom' meeting code if needed. **
Total number of adults (18+ years) living in the home; please include the client:* Please list First and Last Names of other adults:
Total number of children (ages 0-17) living in the home:* Enter 0 if no children are living in the home, otherwise, please enter the number of children.
Does the building have an elevator?* Is there off-street parking for unloading (e.g., parking lot, driveway)?* Please check all that apply:* If Other, please describe:*
Language - Can your client communicate in English?* Our volunteers call to confirm appointments and are also able to help with questions about their order.
Household Items Needed (check any that apply):* What furniture does your client currently have?*
Will client select their items in person or remotely?* Will your client be at Household Goods for their appointment, or will they need to use REMOTE ZOOM (i.e. if movers are scheduled or for other reasons where client cannot come to Acton).
Additional Comments Is there anything else we need to know?
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transportation assistance section
Step 4: Transportation Needs How well do you know this person and their needs? How closely will you work with this client after you make the referral to Household Goods? How do you know your client has an empty apartment? (check all that apply) Have you and your client exhausted all possible options for transporting furniture and household goods from Acton to their home and need transportation assistance to furnish their home? For example, does your client have any family, friends, faith or other community groups who could help rent or drive a truck? Does your agency or other agencies your client is involved with have any financial assistance available?
Please describe your client's current living situation:* Please describe your client's situation and how it relates to their need for furniture.*
What challenges does your client face in transporting goods from Household Goods into their home?*
I agree that if my client is approved for transportation assistance:* I will work closely with my client to ensure that they attend their appointment.
I agree
and* I will ensure that all assistance received through this program will be used for the sole purpose of transporting goods from Household Goods into their home.
I agree
and* If Household Goods arranges for a mover to deliver items to my client’s home, I will personally ensure that my client or a responsible adult is present to accept delivery.
I agree
and* If I do not comply with these agreements, I may become ineligible to apply for this type of support from Household Goods in the future.
I agree
Additional Comments Is there anything else we need to know?
