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



Re-Entry Resource Directory ApplicationThe Florida Department of Corrections welcomes any assistance in providing reentry services to formerly incarcerated Florida residents. We appreciate your organization’s efforts to provide services to empower and equip formerly incarcerated Florida residents to successfully navigate their reentry into the community.Please complete and fill in the required information below for your organization. After completing the required information, submit the completed application, and/or any questions and concerns you may have to: DC-ResourceDirectory@mail.dc.state.fl.us or via fax (850) 922-0847.(THIS IS NOT AN INMATE RE-ENTRY PROGRAMS REGISTRATION APPLICATION, please refer to the weblink and Click on the Resource Inmate Re-Entry Programs Registration Application link.).Name of Organization: Contact Name(s)/Job Title: Address/Location (City, State and Zip Code): Hours/Days of Services: Phone Number/Fax Number: Email Address: Web Address: What counties do you serve? Do you have a current contract with FDC?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 Assistance FORMCHECKBOX FORMCHECKBOX Legal Aid FORMCHECKBOX FORMCHECKBOX Clothing Assistance FORMCHECKBOX FORMCHECKBOX Social Security income FORMCHECKBOX FORMCHECKBOX Debt Management FORMCHECKBOX FORMCHECKBOX Social Security Disability FORMCHECKBOX FORMCHECKBOX Temporary Cash Assistance FORMCHECKBOX FORMCHECKBOX Household items FORMCHECKBOX FORMCHECKBOX Financial Management FORMCHECKBOX FORMCHECKBOX Transportation FORMCHECKBOX FORMCHECKBOX Food Stamp Assistance FORMCHECKBOX FORMCHECKBOX Utilities (Assistance) FORMCHECKBOX FORMCHECKBOX Food/Meals FORMCHECKBOX FORMCHECKBOX Child Support FORMCHECKBOX FORMCHECKBOX Housing Assistance FORMCHECKBOX FORMCHECKBOX Rent Assistance FORMCHECKBOX FORMCHECKBOX Do you provide any of the following education/employment assistance?ServicesReferralsServicesReferralsAdult Education Classes FORMCHECKBOX FORMCHECKBOX Job Fairs FORMCHECKBOX FORMCHECKBOX Basic Skills/Aptitude Test FORMCHECKBOX FORMCHECKBOX Job Placement/Referrals FORMCHECKBOX FORMCHECKBOX Career Counseling FORMCHECKBOX FORMCHECKBOX College Preparation Classes FORMCHECKBOX FORMCHECKBOX Career Exploration FORMCHECKBOX FORMCHECKBOX Resume Guidance/Building FORMCHECKBOX FORMCHECKBOX Day Labor FORMCHECKBOX FORMCHECKBOX Scholarships FORMCHECKBOX FORMCHECKBOX Educational Training FORMCHECKBOX FORMCHECKBOX Unemployment Compensation FORMCHECKBOX FORMCHECKBOX GED Preparation/Testing FORMCHECKBOX FORMCHECKBOX Vocational Rehabilitation/Training FORMCHECKBOX FORMCHECKBOX 1st Step FORMCHECKBOX FORMCHECKBOX Ready to Work Credentials FORMCHECKBOX FORMCHECKBOX Internet Access FORMCHECKBOX FORMCHECKBOX Interest Inventories FORMCHECKBOX FORMCHECKBOX Faith Based Counseling 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 Management FORMCHECKBOX FORMCHECKBOX Detoxification Center FORMCHECKBOX FORMCHECKBOX Well Care (Health Department) FORMCHECKBOX FORMCHECKBOX Eye Care FORMCHECKBOX FORMCHECKBOX Parenting Classes FORMCHECKBOX FORMCHECKBOX Family Service/ Counseling FORMCHECKBOX FORMCHECKBOX Personal Counseling FORMCHECKBOX FORMCHECKBOX Family Planning FORMCHECKBOX FORMCHECKBOX Substance Abuse Counseling FORMCHECKBOX FORMCHECKBOX Free Clinic/Screening FORMCHECKBOX FORMCHECKBOX Veterans Services FORMCHECKBOX FORMCHECKBOX HIV/AIDS Education FORMCHECKBOX FORMCHECKBOX Aftercare Substance Abuse Services FORMCHECKBOX FORMCHECKBOX Psychological Assessment/Testing FORMCHECKBOX FORMCHECKBOX HIV/AIDS Treatment FORMCHECKBOX FORMCHECKBOX Sexual Violence Assistance FORMCHECKBOX FORMCHECKBOX Home Healthcare FORMCHECKBOX FORMCHECKBOX Life Skills FORMCHECKBOX FORMCHECKBOX Immunization FORMCHECKBOX FORMCHECKBOX Physical/Occupational Therapy FORMCHECKBOX FORMCHECKBOX Counseling for Victim Crime FORMCHECKBOX FORMCHECKBOX Adult Day Care FORMCHECKBOX FORMCHECKBOX Sex Offender Counseling FORMCHECKBOX FORMCHECKBOX Health Care FORMCHECKBOX FORMCHECKBOX Speech Therapy FORMCHECKBOX FORMCHECKBOX Mentoring FORMCHECKBOX FORMCHECKBOX Support Groups FORMCHECKBOX FORMCHECKBOX Nursing & Rehabilitation FORMCHECKBOX FORMCHECKBOX Domestic Violence Counseling FORMCHECKBOX FORMCHECKBOX Mental Health Counseling FORMCHECKBOX FORMCHECKBOX Outpatient Substance Use Counseling FORMCHECKBOX FORMCHECKBOX Nutrition FORMCHECKBOX FORMCHECKBOX Domestic Violence Services FORMCHECKBOX FORMCHECKBOX Domestic Violence Housing FORMCHECKBOX FORMCHECKBOX Prescription Assistance FORMCHECKBOX FORMCHECKBOX Mentoring FORMCHECKBOX FORMCHECKBOX Moral Recognition Training (MRT) FORMCHECKBOX FORMCHECKBOX Residential Substance Abuse Counseling FORMCHECKBOX FORMCHECKBOX Sober Living Houses FORMCHECKBOX FORMCHECKBOX Thinking for a Change (T4C) FORMCHECKBOX FORMCHECKBOX No referral needed (Spectrum) FORMCHECKBOX FORMCHECKBOX No referral needed (Transition) FORMCHECKBOX FORMCHECKBOX Do you provide any of the following types of General Assistance?ServicesReferralsHousing/Shelter FORMCHECKBOX FORMCHECKBOX Transportation FORMCHECKBOX FORMCHECKBOX English as a second language FORMCHECKBOX FORMCHECKBOX Human Trafficking Housing FORMCHECKBOX FORMCHECKBOX Drivers Licenses/ Identification FORMCHECKBOX FORMCHECKBOX Referral Services FORMCHECKBOX FORMCHECKBOX Bilingual Assistance FORMCHECKBOX FORMCHECKBOX Refugee Information (ICE) FORMCHECKBOX FORMCHECKBOX Veteran Services FORMCHECKBOX FORMCHECKBOX Disaster/Emergency Shelter FORMCHECKBOX FORMCHECKBOX Comments: ................
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