ABH Client Referral Form

Each ABH case manager must use this ABH Client Referral Form to refer a client to a participating social enterprise and the LA:RISE program. Once each form is submitted, two confirmation emails will automatically be sent: one to the ABH case manager for their records and one to the social enterprise staff so that they are aware of the incoming referral and can follow up.

NOTE: Prior to using the Referral Form, ABH case managers must utilize the ABH-SE Contact Information spreadsheet to determine which social enterprise the client will be referred to based on best fit. It can be found in the ABH Partner Portal here.

ABH client referrals are a two-part process consisting of the initial online Referral Form, followed by the shared Status Spreadsheet for SE staff to track client status updates.

ABH Case Manager Name:*
ABH Case Manager Email:*
ABH Site:*
ABH Client Name:*
First Last
ABH Client Phone Number:
ABH Client Email:
Best Day(s) & Time(s) to Reach Client:
Social Enterprise Referral:*
Pre-enrollment Job Readiness Workshop
The following questions only pertain to clients who have participated in the Pre-enrollment Job Readiness Workshop. This workshop was offered to ABH clients who need additional support before feeling ready to enroll in LA:RISE.
Where did the client complete the Job Readiness Workshop?
Date client completed Job Readiness Workshop
MM slash DD slash YYYY
Is client ready for Transitional Employment?
- Yes
- No, prep phase only
Comments

Pre-enrollment Job Readiness Workshop

Employer Co Inc.

Thank you!

ABH Partner Portal

ABH Client Referral Form

Pre-enrollment Job Readiness Workshop

My name here