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Community Partnership Referrals(2023)
Please know, providing the requested information will help us to collaborate with other community organizations to provide the necessary services where available.
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* Indicates required question
Referring Agency Name
*
Your answer
Referral Contact Name
*
Your answer
Referral Contact Phone Number
*
Your answer
Is customer receiving assistance through any of the following organizations?
*
Workforce Solutions of North Central Texas
Vocational Rehabilitation
Not Applicable
Required
Customer Name
*
Your answer
Customer Phone Number
*
Your answer
Customer email address
(If no email address is available, insert N/A.)
*
Your answer
What
City
does the customer live in?
Your answer
Type of AEL Services is this customer being referred for?
*
High School Equivalence Prep
English as a Second Language
College Prep (TSI)
Citizenship Prep
Other:
Required
What
County
does the customer live in?
Your answer
Does the customer have a valid ID
*
Yes
No
Does the customer have a SS card or an ITIN?
*
Yes
No
Check all that apply
*
Criminal Justice
Foster Care
Have Children
Have a Disability
Homeless
HS Dropout
Other:
Required
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