Admissions & Referrals

Start a referral for residential support

Name: MN Group Home
Address: 6524 Humboldt Avenue South, Richfield, MN, US
Telephone: 952-594-1288

Families, social workers, and county case managers can share the person’s current needs, timing, and support goals. Our team will review the inquiry and follow up to discuss fit, next steps, and available care coordination.

952-594-1288 Mngrouphome@gmail.com

Submit focused details

The form collects contact, applicant, urgency, and support information so the inquiry starts with useful context.

Attach planning documents

Upload a support plan, CSSP, or related document when available to reduce follow-up and clarify service fit.

Expect direct follow-up

A team member follows up using the preferred contact method to discuss fit, timing, and next steps.

Referral readiness

Details that help us review faster

You can submit the form with the information you have today. These items simply help the follow-up conversation move more quickly.

Current living setting and target move timeline
County of financial responsibility
Guardian or representative contact information
Primary support needs, routines, risks, and wellness considerations
Support Plan, CSSP, or related referral document when available

Please do not send Social Security numbers or full medical records through the website form.

MN Group Home

CRS Referral Inquiry Form

Please share enough information for our team to follow up. Do not include Social Security numbers or highly sensitive medical records in this website form.

Required info progress0%

Optional details and documents can still help us respond with a better first follow-up.

Referral submissions are sent to Mngrouphome@gmail.com. A MN Group Home team member will follow up by the preferred contact method.

Submitter Information

Submitter full name *Role / agency *Email address *Phone number *Preferred contact method

Applicant Information

Applicant full name *Preferred name Preferred pronouns Date of birth County of financial responsibility *Current living setting

Guardian or Representative

Guardian / representative name Guardian / representative contact

Services and Support Needs

Referral urgency

Services and support areas being requested

0 selected

Community Residential Services245D waiver services

Brief description of the individual’s needs *

Support Plan / CSSP Upload

Upload Support Plan, CSSP, or related referral documentAccepted file types: PDF, Word documents, images, or text files. Maximum size: 10 MB.Choose Support Plan / CSSP fileOptional, but helpful for case manager referrals.

Electronic Signature

By typing your name and dating this form, you confirm that the information provided is accurate to the best of your knowledge and that MN Group Home may contact you about this referral.

Electronic signature *Signature date *

I understand this form sends a referral inquiry to MN Group Home and should not include Social Security numbers or full medical records.