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SEE Referral
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
Select All
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
November 4th
November 24th
Tab #3
November 4th
November 24th
Item #3
November 04, 2025
These things were done on this day.
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November 4
