Address: 223 N. Yakima Ave. Tacoma, WA 98403 Phone: (253) 722- 5685 Lutheran Community Service Northwest, Refugee Resettlement Agency
Recept ion
Assura nce 1st Home Visit
Intake Interv iew
Public Benefits Enrollm ent
Social Security number
Eligible Services Enrollm ent
Other Referrals & Assistance
Case Closeout
Airport pickup with -
Appropriate interpretation
Seasonal clothing
Pocket money
Culturally appropriate ready-to eat food
Housing Evaluati on Safety checklis t
US Ties Coordin ation
Housing and Safety Orientation
Assessment
Assistance with basic needs
Orientation – Roles and Responsibil ities
Verify refugee documenta tion
Public Assistance SNAP & MA Eligible Services Enrollment
Social Security Number application
ESL Referral and Enrollment Assistance
Employment program Referral and Enrollment Assistance
Other welfare program (WIC)
Health Screening Referral and Appointment
School Registration
Selective Service Registration
Service/ Resettlement plan
Cultural Orientation
Assistance with AR 11
Documented -
Throughout the 90 days R&P Service Period:
Individualized, detail case notes that include explanation for service delays
CO assessment
Documentation of CO understanding
Food and food allowance until SNAP
Washington State Individual Refugee and Special Immigrant Visas Arrival
When completing this form list the specific quantities provided, as checkmarks or “enough” are not acceptable responses
Mattress and box spring (only married couples or small children of same gender may be expected to share beds)
Bed frame
One set of drawers, shelves or other unit appropriate for storage of clothing per family
One couch or equivalent seating per family (in addition to kitchen chairs)
One lamp per room, unless installed lighting is present and adequate, and light bulbs as needed
Kitchen table (per case) and chair (per person)
Linens and Other Household Supplies
One bath towel per person
One set of sheets for each bed
Blanket(s) for each bed as seasonally appropriate
One pillow and pillowcase for each person
Alarm clock
Paper, pens and/or pencils
(one set per case recommended)
Cleaning Supplies
Dish soap
Bathroom/kitchen cleanser
Laundry detergent
Sponges or cleaning rags and/or paper towels
One place setting of tableware (fork, knife, spoon) per person
One place setting of dishes (plate, bowl and cup) per person
Pots and pans: at least one sauce pan, frying pan, and baking dish
Mixing/serving bowls
One set of kitchen utensils (such as a spatula, wooden spoon, knife, serving utensils, etc.)
Can opener
Toiletries (new)
Toilet paper (list number of rolls)
Shampoo
Soap
One toothbrush per person
Toothpaste
Personal hygiene items as appropriate (such as deodorant, feminine hygiene products, and razors)
Two waste baskets
Trash bags (list number of boxes)
Mop or broom
Other Items and Food Description
Appropriate seasonal clothing for work, school and everyday use: Clean clothing, in good condition, for all members of the family (including proper footwear)
Baby items as needed: such as baby food, clothing, diapers, infant and children car seats, and cribs
Food available on arrival: Culturally appropriate, ready-to-eat food, plus one day’s worth of additional food supplies and staples (including baby food as needed)
Food within one day of arrival: Food or food allowance at least equivalent to the food stamp allocation for that family unit and continued food assistance until receipt of food stamps or until individual/ family is able to provide food for himself, herself or themselves
PA Name: Signature: Date:
Case Manager Name: Signature: Date:
Interpreter Name: Signature: Date:
PA Name: Case #: List Completed by:
Size: DOA: # of Occupants: Date Completed:
Temporary (T) or Permanent (P) Housing: Furniture Quantity Kitchen Items Quantity
Case
Address:
Key Contacts for Lutheran Community Services Multicultural Services:
1. Morgan ChristianSen mchristiansen@lcsnw.org 253-722-5685
Housing Specialist and Volunteer Mentoring Coordinator
2. John Forseth jforseth@lcsnw.org 253-722-5695
Program Director Refugee Resettlment and Placement 3. Paul Tan, M.Div.
Foster Home Recruiter Refugee and Immigrant Children’s Program
www.refugeechildren.net 4. Kinza Schulyer kschuyler@lcsnw.org
Immigration Services Northgate Office
5. Beth Farmer bfarmer@lcsnw.org
Lutheran Community Service International Counseling and Community Services for Refugee Mental Health and Asylee Program.
6. Advocacy Go to website www.lirs.org and sign up for “Stand For Welcome” alerts and take action.
JoAnne Kelsey
Assistant Director for Advocacy
Jkelsey@lirs.org