Skip to main content

Referral for Grant Funded Employment Services

This website uses standard Transport Layer Security (TLS) protocols to encrypt data submitted over this form.

GRANT ELIGIBILITY REQUIREMENTS

Does your agency have a Community Partnership Agreement with Career Support Systems?
Does the person being referred have a custodial or non-custodial child under 18?
Does the person have income that is at or below 200% of the Federal Poverty Guidelines?

PERSONAL DATA

Name
Address

DISABILITY INFORMATION

Does the person being referred have a diagnosed disability?

REFERRING AGENCY INFO

CAPTCHA