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Services
Our Model
Outcomes
Referral Process
Partnership
Submit a Referral
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Referral Intake Form
The Continuum Project
1. Referring Agency Information
Agency Name
Contact Person
Title
Phone
Email
Preferred Method of Communication
Select
Email
Phone
Either
2. Participant Information
Full Name
Date of Birth
Current Status
Select status
Currently Incarcerated
Recently Released
On Parole
On Probation
In Transitional Housing
Other
Current Location
Anticipated Placement Date
Employment Status
Select
Unemployed
Employed Part-Time
Employed Full-Time
Actively Seeking
3. Support Needs
Housing coordination needed?
Select
Yes
No
Workforce support needed?
Select
Yes
No
Case management required?
Select
Yes
No
4. Risk / Compliance Considerations
Any known safety concerns?
Required supervision conditions?
Special considerations?
5. Documentation Upload
Referral Summary
Identification
Relevant Documentation
6. Agreement
I confirm that the information provided is accurate to the best of my knowledge.
Submit Referral
