№ files_lp_4_process_1_36725
File format: docx
Character count: 2465
File size: 108 KB
Structured form for individuals applying to the ESTA Program detailing personal information, consent, and requested services related to housing and workforce development.
Year:
2026
Organization:
Eliada
Program:
ESTA Program
Document Type:
Referral Form
Intended Audience:
Applicants for housing and workforce development assistance
Required Information:
Full Name, Other Names, Preferred Name, Birth Date, Place of Birth, Citizenship, Social Security Number, Contact Information, Current Address, Employment and Income Details
Consent:
Applicant signature required for contact and verification
Services Requested:
Housing assistance, Workforce development support
Signature Date:
Provided by applicant
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2021
Region / City:
United States
Topic:
Visa Waiver Program, Travel Authorization
Document Type:
Government Website Help
Agency / Organization:
Department of Homeland Security, U.S. Customs and Border Protection
Author:
U.S. Department of Homeland Security
Target Audience:
Travelers from Visa Waiver Program countries
Period of Validity:
2 years from approval or passport expiration
Date of Approval:
2021
Date of Changes:
None specified
Year:
2021
Region / City:
Victoria, Australia
Topic:
Emergency Services, COVID-19, Ambulance, Staff Issues
Document Type:
Meeting Summary
Organization:
ESTA, AEAV
Author:
AEAV
Target Audience:
ESTA Members, AEAV Members
Period of Validity:
2021-2022
Approval Date:
2021-09-23
Date of Last Changes:
2021-09-23
Year:
2023
Region / City:
Penn Yan, NY
Topic:
Mental Health Services, Housing Assistance
Document Type:
Referral Form
Organization:
Yates County Adult SPOA
Author:
Yates County Mental Health Services
Target Audience:
Health and social service providers, individuals with mental health concerns
Effective Period:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Contextual Description:
A referral form for supportive housing, ACT services, and non-Medicaid care management for individuals with mental health diagnoses in Yates County.
Year:
2023
Region / City:
North Central London
Topic:
Healthcare Referral Form
Document Type:
Referral Form
Organization / Institution:
North Central London
Author:
N/A
Target Audience:
Healthcare professionals
Period of Validity:
N/A
Approval Date:
N/A
Amendment Date:
N/A
Year:
2020
Region / City:
United States
Theme:
Emergency Housing Assistance, COVID-19 Response
Document Type:
Referral Form
Author:
SSVF
Target Audience:
Veterans, SSVF Grantees, Community Stakeholders
Action Period:
During COVID-19 Pandemic
Approval Date:
N/A
Date of Changes:
N/A
Context:
A referral form used for Emergency Housing Assistance under the SSVF program during the COVID-19 crisis, outlining eligibility and procedures for providing temporary housing to at-risk Veterans.
Year:
20XX
Region / City:
Illinois
Topic:
Affordable Housing
Document Type:
Agreement
Organization / Institution:
Illinois Housing Development Authority
Author:
Not specified
Target Audience:
Property Managers, Housing Authorities, Service Providers
Effective Period:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2024
Region / City:
Gwent, Wales
Theme:
Child Safeguarding
Document Type:
Referral Form
Institution / Organization:
Various Local Authorities in Wales
Author:
Not specified
Target Audience:
Professionals involved in child safeguarding
Period of validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2023
Region / City:
Perth, Australia
Topic:
Psychosocial support, Mental health recovery, Social services
Document type:
Referral form
Organization:
Richmind WA
Target Audience:
Individuals experiencing mental health challenges
Period of validity:
6 to 12 months
Date of approval:
Not specified
Date of amendments:
Not specified
Year:
2023
Region / City:
Inner Eastern Melbourne, Outer Eastern Melbourne, Southern Melbourne, Inner Gippsland, Outer Gippsland
Subject:
Early childhood support, National Disability Insurance Scheme
Document type:
Referral form
Organization / Institution:
National Disability Insurance Scheme (NDIS)
Author:
National Disability Insurance Scheme (NDIS)
Target audience:
Families and carers of children with developmental concerns or disabilities under 9 years old
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Year:
2025
Region / City:
Wisconsin
Subject:
Referral Process for Nursing Home Residents Regarding Return to the Community
Document Type:
Instructional Form
Agency:
Department of Health Services (DHS)
Author:
Division of Quality of Assurance
Target Audience:
Skilled Nursing Facility (SNF) Staff
Period of Validity:
Not Specified
Approval Date:
Not Specified
Modification Date:
Not Specified
Year:
Not specified
Region / City:
Devon, England
Theme:
Adult ADHD Assessment and Treatment
Document Type:
Referral Form
Organization / Institution:
Harrow Health CIC
Author:
Not specified
Target Audience:
Healthcare professionals, GPs
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2026
Region / City:
United Kingdom
Topic:
Paediatric fatigue assessment and referral
Document Type:
Referral Form
Organization / Institution:
NHS
Author:
Not specified
Target Audience:
Healthcare professionals
Period of Validity:
Indefinite
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2025
Date:
7 April 2025
Region / City:
Swindon and Wiltshire, Gloucestershire
Country:
United Kingdom
Healthcare System:
NHS
Clinical Area:
Diabetes foot care
Topic:
Diabetic foot ulcer referral pathways
Document Type:
Clinical referral guidance and referral form
Issuing Organizations:
Gloucestershire Hospitals NHS Foundation Trust; Wiltshire Community Podiatry; Swindon Community Podiatry
Target Audience:
General practitioners, community podiatrists, healthcare professionals
Referral Pathways:
Same Day Emergency Care (SDEC); Foot Attack Clinic; Community Podiatry; Vascular Surgery
Urgency Categories:
Urgent referrals; Routine referrals
Associated Services:
Diabetes Foot MDT; Community Diabetes Teams
Clinical Conditions Covered:
Diabetic foot ulceration; infection; ischaemia; Charcot foot; neuropathy
Required Clinical Information:
Patient demographics; diabetes history; comorbidities; ulcer characteristics; investigations; treatments
Investigations Referenced:
Blood tests; wound swab; tissue sample; X-ray; ultrasound
Contact Methods:
Email referrals; ERS submissions; telephone
Period of Applicability:
Ongoing as of April 2025
Year:
2026
Region / City:
Oxford, UK
Document Type:
Referral Form
Institution:
Oxford University Hospitals NHS Foundation Trust
Intended Audience:
General Practitioners, Hospital Consultants
Clinical Focus:
Bone and Joint Infections
Required Attachments:
Imaging, Microbiology Results
Referral Method:
Direct email for hospital referrals, e-referral service for GPs
Patient Eligibility:
UK residents
Year:
2024
Region / City:
Minnesota
Subject:
Child Care, Training Delivery
Document Type:
RFP (Request for Proposals)
Organ / Institution:
DCYF (Department of Children, Youth, and Families)
Author:
Not specified
Target Audience:
Organizations or agencies applying to provide child care training services
Period of Action:
FY26/FY27
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2024
Region / City:
Denbighshire
Theme:
Housing Support
Document Type:
Referral Form
Organization / Institution:
Denbighshire County Council
Author:
Denbighshire County Council
Target Audience:
Social Services, Health, Local Authority Homeless Team, Police, Probation, YOT, Housing Associations, Hostels, and other related services
Effective Period:
From April 1st, 2024
Approval Date:
January 2024
Date of Changes:
N/A
Year:
2020-2027
Region / City:
Southern Company Gas
Subject:
DIMP Capital Budget and Pipe Replacements
Document Type:
Proposed Budget Report
Organization / Institution:
Southern Company Gas
Author:
Steven Murphy, Vice President, Engineering & Construction, Southern Company Gas; Donald Carter, Vice President, Compliance & Technical Services, Southern Company Gas
Target Audience:
Stakeholders involved in DIMP program and budget approval
Effective Period:
2020-2027
Approval Date:
2020
Date of Changes:
None provided
Note:
Year
Topic:
Physiotherapy, Workplace Injury Rehabilitation
Document Type:
Form
Organization / Institution:
WorkSafeBC
Target Audience:
Employers, Physiotherapy Providers