For referring individuals to PRIDE from the Department of Rehabilitation or any Regional Center, please follow the guidelines below:
The Forms
All of the required forms are provided in Adobe Acrobat format (.pdf); some of them are available in Microsoft Word 97 (.doc). Choose the format appropriate for you. If you do not have Microsoft Word or are unsure, select the Acrobat format, since the reader is available free. (You may download Adobe Reader from Adobe's website.) Complete the forms and return them to PRIDE. If you choose Microsoft Word, you can email the completed form to us if you wish.
Download the "PRIDE New Start Referral Checklist"
PRIDE Industries may require several or all of the documents noted on this Referral Checklist during the intake process. Please keep this document for your reference and a PRIDE Industries Vocational Rehabilitation Counselor or Intake Coordinator will advise you on the needed documents depending on the service requested.
Download the "PRIDE Aggressive Behavior Statement"
(Acrobat Version) (MS Word Version) Form required
In order to provide appropriate Vocational Rehabilitation Services insuring the safety of both the employee and program staff, PRIDE Industries requires any available information related to aggressive or dangerous behaviors. Failure to disclose this information may jeopardize the success of an employee's services.Download the "PRIDE Referral Form"
(Acrobat Version) (MS Word Version) Form required
Submission of this form initiates the intake process for receiving services from PRIDE Industries. Complete each section in its entirety providing all information and answering all questions as applicable. The requested services, start date, work days/hours, and location will be determined for appropriateness and finalized as the intake process progresses.Email, fax, or mail the forms to PRIDE Industries.
The Aggressive Behavior Statement and Referral Form are required for this referral intake process. Please use the links below to locate the address, fax, or e-mail information of the PRIDE Industries representative you wish to receive this information.
To send directly to the person you have spoken with: Select By Person's Name
To send directly to the location of your choice: Select By Location
ORClick here to email the two completed forms (excluding checklist) to PRIDE Referral Intake. In the email, please state the name of the person at PRIDE with whom you spoke so the intake forms may be appropriately directed.
For more information, contact our Rehabilitation Services team at (800) 550-6005 or use our online contact form.
