Calling sheet for Resource Providers (separate sheets for ...



Re-Entry Resource Directory ApplicationThe Florida Department of Corrections welcomes any assistance in providing transition services to our ex-offender population.?The need for reentry services is great.?We highly respect that your organization is attempting to assist this disadvantaged population with the many challenges they face upon reentry.??? Please fill in the information below for your organization. Please be as specific as possible and provide contact names where feasible. Please submit the completed information sheet to DC-ResourceDirectory@mail.dc.state.fl.us or via fax (850) 410-4559.??Thank you for your willingness and desire to assist our ex-offender population.? It is gratifying to know that others share a concern for those committed to our care.?If you have any questions, please feel free to contact Sam Wescoat at (850) 717-9940 or DC-Resource Directory@mail.dc.state.fl.us Name of Organization: Contact Name: Address/Location: Hours/Days of Services: Phone Number/Fax Number: Email Address: Web Address: What areas of the county do you serve? Who can receive your services? What paperwork does the client need to bring? What restrictions do you have?What are the fees for your service? Do you provide any of the following types of financial assistance services?ServicesReferralsServicesReferralsChild Care FORMCHECKBOX FORMCHECKBOX Security Deposit FORMCHECKBOX FORMCHECKBOX Clothing FORMCHECKBOX FORMCHECKBOX Social Security income FORMCHECKBOX FORMCHECKBOX Debt Management FORMCHECKBOX FORMCHECKBOX Social Security Disability FORMCHECKBOX FORMCHECKBOX Energy Assistance FORMCHECKBOX FORMCHECKBOX Temporary Cash Assistance FORMCHECKBOX FORMCHECKBOX Financial Counseling FORMCHECKBOX FORMCHECKBOX Transportation FORMCHECKBOX FORMCHECKBOX Food Stamps FORMCHECKBOX FORMCHECKBOX Utilities FORMCHECKBOX FORMCHECKBOX Food/Meals FORMCHECKBOX FORMCHECKBOX Child Support Assistance FORMCHECKBOX FORMCHECKBOX Household Items FORMCHECKBOX FORMCHECKBOX Rent Assistance FORMCHECKBOX FORMCHECKBOX Do you provide any of the following education/employment assistance?ServicesReferralsServicesReferralsAdult Basic Education FORMCHECKBOX FORMCHECKBOX Job Interview Support FORMCHECKBOX FORMCHECKBOX Basic skills/Aptitude Test FORMCHECKBOX FORMCHECKBOX Job Placement/Referrals FORMCHECKBOX FORMCHECKBOX Career Counseling FORMCHECKBOX FORMCHECKBOX Job Search Assistance FORMCHECKBOX FORMCHECKBOX Career Exploration FORMCHECKBOX FORMCHECKBOX Resume Guidance/Building FORMCHECKBOX FORMCHECKBOX Day Labor FORMCHECKBOX FORMCHECKBOX Scholarship for Training FORMCHECKBOX FORMCHECKBOX Educational Training FORMCHECKBOX FORMCHECKBOX Unemployment Compensation FORMCHECKBOX FORMCHECKBOX GED Preparation FORMCHECKBOX FORMCHECKBOX Vocational Rehabilitation/Training FORMCHECKBOX FORMCHECKBOX GED Testing FORMCHECKBOX FORMCHECKBOX Ready to Work Credentialing FORMCHECKBOX FORMCHECKBOX Do you provide any of the following types of health care assistance?Anger Management FORMCHECKBOX FORMCHECKBOX Marriage Counseling FORMCHECKBOX FORMCHECKBOX Dental Care FORMCHECKBOX FORMCHECKBOX Medication Assistance FORMCHECKBOX FORMCHECKBOX Detoxification Center FORMCHECKBOX FORMCHECKBOX NA/AA Meetings FORMCHECKBOX FORMCHECKBOX Eye Care FORMCHECKBOX FORMCHECKBOX Parenting Classes FORMCHECKBOX FORMCHECKBOX Family Counseling FORMCHECKBOX FORMCHECKBOX Persons Counseling FORMCHECKBOX FORMCHECKBOX Family Planning FORMCHECKBOX FORMCHECKBOX Substance Abuse Counseling FORMCHECKBOX FORMCHECKBOX Free Clinic FORMCHECKBOX FORMCHECKBOX Veterans Health Services FORMCHECKBOX FORMCHECKBOX HIV/AIDS Treatment FORMCHECKBOX FORMCHECKBOX Sexual Violence Assistance FORMCHECKBOX FORMCHECKBOX Immunization FORMCHECKBOX FORMCHECKBOX Physical/Occupational Therapy FORMCHECKBOX FORMCHECKBOX In-Patient Services FORMCHECKBOX FORMCHECKBOX Residential Treatment Shelter FORMCHECKBOX FORMCHECKBOX Sex Offender Counseling FORMCHECKBOX FORMCHECKBOX Health Care FORMCHECKBOX FORMCHECKBOX Speech Therapy FORMCHECKBOX FORMCHECKBOX Mentoring FORMCHECKBOX FORMCHECKBOX Support Group FORMCHECKBOX FORMCHECKBOX Nursing & Rehabilitation FORMCHECKBOX FORMCHECKBOX Domestic Violence FORMCHECKBOX FORMCHECKBOX Mental Health Counseling FORMCHECKBOX FORMCHECKBOX Out Patient Counseling FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you provide any of the following types of General Assistance?ServicesReferralsHousing/Shelter FORMCHECKBOX FORMCHECKBOX Transportation FORMCHECKBOX FORMCHECKBOX Transitional Housing FORMCHECKBOX FORMCHECKBOX Soup Kitchen FORMCHECKBOX FORMCHECKBOX Clothes FORMCHECKBOX FORMCHECKBOX Drivers Licenses FORMCHECKBOX FORMCHECKBOX Referral Services FORMCHECKBOX FORMCHECKBOX Bilingual Assistance FORMCHECKBOX FORMCHECKBOX Refugee Information FORMCHECKBOX FORMCHECKBOX Legal Aid FORMCHECKBOX FORMCHECKBOX Disaster/Emergency Shelter FORMCHECKBOX FORMCHECKBOX Comments: ................
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