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SEE Referral

Name

This field is for validation purposes and should be left unchanged.

First Name(Required)

Last Name(Required)

Phone(Required)

Email(Required)

What is the best way to contact you?

Call

Email

Text

How did you hear about us?

El Barrio

My SUD Counselor

My MAT Provider

ACT Team

STARS/FIRST Team

Event Flyer

The Centers’ Advertising

Permanent Supportive Housing

Other Provider/Other

What was the name of the person who referred you?

Are you in treatment or recovery from alcohol or other substances??(Required)

I’m in recovery from drugs or alcohol.

I’m in treatment for drugs or alcohol.

I’m looking for treatment for drugs or alcohol.

I’m just looking for a job.

What are you interested in?(Required)

Supported Employment & Education

Substance Use Disorder Treatment

El Barrio Workforce Development Training

Check all that apply.

Are you interested in gaining more education to advance your career goals?

Yes

No

More Info

Please tell us more about your employment goals:

What job (type of job, hours, etc.) would be a good match for you? What are some of your strengths? (experience, training, personality, support, etc.)

Notes

A photo of the inside of the Glick Recovery Campus meant to show progress on the construction

A photo of the outside of the Glick Recovery Campus meant to show progress on the construction

November 4th

November 24th

Item #3

November 04, 2025

These things were done on this day.