Sharing Connections Furniture Bank - Accessing our services

New Agent Online Application

Complete the information below to be considered for our Referring Agent Network. Please understand that you will be contacted in the event your agency is approved. We are only considering agencies when an opening arises - however, completing this form does not guarantee acceptance. Due to the amount of requests we are receiving, we cannot check on the status of requests submitted.

We are currently only accepting New Agent/Agency applications from DuPage County. We do not maintain a waitlist.

Complete all the fields below:

Your Name :
Agency Name :
Are there other agents at this agency that currently refer clients? :
What is your agency email address (personal email not accepted, i.e. gmail, yahoo, etc.) :
What is your current job title :
What is your work phone number, including area code :
What is your work mailing address :
What County are you located in? :
What geographic area do you serve? :
Tell us a little about your agency :
What is your non-profit 501(c)(3) number? :

Read the following information and acknowledge that you understand and agree with each statement by entering your initials in the designated areas:

	I agree to only refer clients that fall under the SCFB guidelines (up to 250% of the HHS Poverty Guidelines).
	I understand that my position must be a counselor, social worker, crisis manager or in that related field.
	I understand that I must accurately assess the client's furniture needs and only request furniture the client currently does not have. In addition, I will inform my client that all items provided by SCFB are gently used items donated by the community. SCFB does not provide new items.
	I understand that I can only refer a client for beds if a home visit is conducted. I also acknowledge that twin mattress sets are only provided to individuals under the age of 18. Limits do apply.
	I agree to provide a "Client Preparation List " to my clients informing them of important information they need to know prior to their furniture pickup. This option will be available once the referral is submitted via the online system.
	I agree to inform the client of the $50 access fee payable at the time of the pickup by cash, money order or cashiers check (unless paid by the referring agency).
	I agree to inform the client that they must present a valid photo ID on the day of pickup.
	I agree to inform the client that they must have a vehicle large enough to safely transport the furniture items selected. In addition, the client is responsible for bringing any rope to secure transport of items when using an open bed truck and any additional materials (plastic, etc.) in poor weather conditions.
	I agree to inform the client that they are responsible for bringing a maximum of two (2) individuals to help load their vehicle. Staff and volunteers are not permitted to load vehicles. The warehouse is not suitable for small children.
	I will inform the client that this is a "once in a lifetime" program, so keeping an appointment date is vital to receiving the services of SCFB. A missed appointment may disqualify client from using our services in the future.
	I, the potential referring agent, agree NOT to share any information that is accessible through the online referral system with any individuals (including the client). This information is to be treated as confidential and only accessible by SCFB and the referring agent. This includes all references to the Referral ID # provided per the online system. Providing this number (through conversation, printed screen shots, printed materials) to a client gives them direct access to the online referral where updates can be posted under your name.
	I agree that if I am approved to use this referral system that I WILL NOT submit referrals on behalf of co-workers under my name. I understand that it is my responsibility to only refer clients that are working directly with me.

As part of becoming an approved agent, a tour of the SCFB facility is required.

Please enter a suggested date and time (mm/dd/yy @ hh:mm) in the field to the right that may work best with your schedule. Tour times can be Mon.-Fri. from 10am until 2pm. This is a suggested date and can be changed to fit your schedule.

Once you select the SUBMIT APPLICATION below, your information will be provided to the Director of Program & Operations for review. Please note that response time is directly tied to the amount of applications received. All applications received that are incomplete will be discarded without notice.

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Attention Agencies and Clients - we DO NOT provide new furniture and household items per our wish lists. The items provided are gently used donations from the community.