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Career Services and Job Placement

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Sweetwater County Workforce Services Network Referral Form

Last Name:_______________________       First Name:____________________       MI:_______

Address:____________________________________       County:________________________

City:____________________________    State:_____________________   Zip:_____________

 Phone(Daytime):________________________              Phone(Evening)_____________________

Social Security Number:______________________________   Birthdate:___________________

Former Name(s):____________________________________    Wyoming Resident:  Y___   N___

Gender:   M____ F____     Marital Status:   S___M___W___D___SEP___    US Citizen: Y____N____

Ethnic Status: Caucasian/White____    Hispanic___     African-American___    
Native American___      Asian___    Other___

Client Household Information:

  Name

SSN

DOB

Relationship

       
     

 

Information Exchange Consent Agreement on File at______________________________

What Are My Needs:  Food___   Clothing___   Child Care___   Shelter___    Medical___               Transportation___    Job___   Training___               Utilities/phone____        Other_______________________

Signature____________________________________________      Date__________________

Resources

Name:____________________________        SSN:_____________________

          Last                     First                MI 

I (we) use 

I (we) need info.

Medical Services

Date of Referral

 

 

1.   Medical Primary Physician

 

 

 

2.   Immunization/Well Child Facility

 

 

 

3.   Family Planning

 

 

 

4.   Dental Services

 

 

 

5.   Optical—Eye Glasses

 

 

 

6.   Counseling Services

 

 

 

7.   Prenatal Care/Classes

 

 

 

8.   Mental Health Services

 

 

 

9.   Substance Abuse

 

 

 

10.  Family Violence (YWCA-SASH)

 

 

 

11.  Health Care for Homeless

 

 

 

General Services

 

 

 

12.  Best Beginnings Supplemental Funds for Pregnant Women

 

 

 

13.    Presumptive Eligibility for pregnant women  

 

 

 

14.  Women/Infant and Children (WIC)

 

 

 

15.  Centsible Nutrition

 

 

 

16.  Food Stamps/Food Bank

 

 

 

17.  Equality Care (Medicaid, Kid Care)

 

 

 

18.    POWER:  Personal Opportunities with Employment Responsibilities/TANF         Case Worker:

 

 

 

19.  Travel Assistance for Medical

 

 

 

20.  Housing

 

 

 

18.    Utility Assistance (LIEAP) & Energy Share of Wyoming

 

 

 

22.  Telephone Assistance

 

 

 

23.  Children’s Special Health

 

 

 

24.  SSI/Social Security

 

 

 

25.  Waiver Services  Adult or Child

 

 

 

26.  Respite Care

 

 

 

27.  Foster Care

 

 

 

28.  Emergency Medical Services

 

 

 

Educational Services

 

 

 

29.  Parenting Classes

 

 

 

30.  Parent Support Groups

 

 

 

31.  Developmental Center (CDC)

 

 

 

32.  Head Start

 

 

 

33.  Preschool/Child Care

 

 

 

34.  School/College

 

 

 

35.  Transition Planning

 

 

 

36.  SWRC

 

 

 

37.  Skills Training/WWCC

 

I (we) use

I (we) need info.

Employment Services 

Date of Referral

 

 

37 Job Training/Job Listings

 

 

 

38.  Reliable Transportation

 

 

 

39.  Unemployment Services

 

 

 

40.  Job Corps

 

 

 

41.  Vocational Rehabilitation

 

 

Sweetwater County Resources

 

Agency

Telephone Number

Services

Best Beginnings

(Supervised by Community Nursing)

352-6830

872-6320

Info and referrals for pregnant women and families; financial assistance to pre-natal care; dental program, home visits; parenting classes

Caring Program for Children

800-544-9364

Free health insurance for children (0-18) in financial need

Catholic Social Services

382-2642

Adoption counseling and services

Cent$sible Nutrition

352-6775

872-6310

Free cooking classes; housed by WWCC

Child Care Finder

888-875-0633

362-6230

Licensed assistance in locating safe day care services

Child Development Center

352-6871

872-3290

Early developmental screening; services for children (0-5) with disabilities; parenting education; home-based services.

Child Support Division

800-742-3098

875-4725

Child support enforcement services

Coat Bank

352-6878

352-1471

Free coats for entire family

Community Nursing

352-6830

Childbirth classes for teens; home visits for first-time parents; immunization clinic; drop-in clinic; HIV testing; home health visits

Consumer Credit Counseling

800-390-2227

Negotiation with credit card companies; budget planning/counseling (non-profit)

Dept of Family Services

362-5630

875-2877

Medicaid; Kid Care; food stamps; day care asst; family social services; Lin-up America phone bill applications

Department of Vocational Rehabilitation

382-7660

Disabled services and training

Employment Resources

382-2747

875-2300

Employment referrals; education & training services

Energy Share of Wyoming

742-5414

Assistance with electric bills for low-income persons

Family Planning

362-6813

Pregnancy tests; pelvic exams; birth control education and supplies; STD testing

Family Resource Center

875-3791

Programs for children and families

Fire Department

352-1475

Infant/child care seat reduces cost program; installation instructions

“First Call For Help”

382-5724

875-9600

Information and referral service

Food Bank

382-7332

875-9600

Free supplemental food (semi-monthly) to low-income families.  Food p/u in RS 2nd & 4th Thurs/GR 1st & 3rd Thurs; Emergency Assistance

Head Start

352-3400

Pre-kindergarten education through school district

Job Corps

362-6500

Counseling and training

La Leche League (Lisa)

875-7708

Breastfeeding instruction/support group; meet 3rd Thurs of mo/10 am

LIEAP

800-246-4221

Low Income Energy Assistance Program – help with winter heating costs

Low-Income Housing

382-5598

Bicentennial Apartments

 

352-1471

Rock Springs Housing Authority

 

382-5335

Springview Manor Apartments

 

875-7760

Sundance Apartments

 

 

 

Memorial Hospital

362-3711

875-7730

Childbirth and breastfeeding classes

NOWCAP

382-4740

Energy efficient home improvements for low-income families

Parenting Classes/Support Groups:

 

 

Commonsense Parenting

352-6677

Parenting facilitated by Southwest Counseling

Nurturing Program (0-5)

352-6830

872-6320

12-week parenting class & support group

Agency

Telephone Number

Services

Parents of Children w/Spec Needs

352-3293

Support group – Wt. Mtn. Library – 1st Wed. of every month 10-12 noon and 7-9 pm

Rethink Parenting Program

352-3430

5-week anger management program (family)

Physicians:

     Cygan

     Tolliver

     Women’s Center

     Cournoyer

     Hunter

     Long

     Mosher

     Richardson

     Roberts

     Sloan

     Stachon

     Tan

 

362-0330

875-2211

362-1861

382-9101

382-7414

875-6010/362-9120

875-6010/362-1920

382-8668

875-6010/362-9120

875-6010/3629120

382-8644

382-7778

 

Pediatrics

Pediatrics

Drs. Allyn, Fagnant and Kaan OB/GYN

Respite Care

352-6847

 

Rosen Recovery Center (SCS)

352-6685

In-patient substance abuse treatment; AA/NA

Salvation Army

362-3711

352-6830

Low-income emergency assistance ($100/year)

SASH (YWCA)

352-1033/872-3250

352-6630/872-3252

Crisis line; shelter domestic violence/sexual assault; advocacy; information & referrals.  Call crisis line to secure pick-up & transportation for women and children of domestic violence

Social Security Adm.

800-453-8853

SSDI, SSI, Death Benefit & retirement

Social Services (church-based)

Catholic Social Services

LDS Social Services

 

382-9114

(801) 969-4181

 

Adoption counseling and services

Adoption counseling and services

Southwest Counseling Services

352-6677

872-3205

Counseling/therapy; outpatient substance abuse treatment; sliding scale fees

Southwest Wyoming Rehabilitation Center

382-2842

Disabled services, housing and training

Star Bus

382-7827/875-7827

Public transportation: 7 am- 5 pm Mon-Fri

Unemployment Insurance

473-3789

Unemployment benefits information

Vista Bible Church

362-1241

Free Clothing – MWF 9:30 and – 11:30 am - annex

Western Wyoming College

Job Placement and Occupational Services

Rock Springs Campus

Green River Campus

 

382-1761

382-1600

875-2278

 

One stop. Perkins/WDTF training funds/nontraditional programs.  Financial aid; student housing and non-infant day care.

WIC

352-6783

877-800-6783

Supplemental food and nutritional instruction for parental women and children 0-5; breast-feeding education and support group.

Wyoming Children’s Society

800-584-9384

Adoption counseling and services

Wyoming Health Initiative

382-3060

Financial assistance for teen prenatal services; free teen pregnancy tests

Young At Heart Senior Center

352-6737

Senior citizen services, meals on wheels

Youth Crises Center

352-6762

 

YWCA

352-6635

872-3251

Big brothers and big sisters; day care center

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Mark Rembacz
Career Services and Placement Coordinator
382-1646

Peg Larson
Occupational/Student Success Advisor
(307)382-1828

Brenda Haskins
Career Services and Job Placement Assistant
382-1660

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