Page 708

VIRGINIA DEPARTMENT OF SOCIAL SERVICES RE-ENTRY REFERRAL SHEET

10/24 VOLUME V, PART XXV, APPENDIX II, PAGE 42

Local Department of Social Services Re-Entry Client Referral Sheet

FORM NUMBER - 032-03-0412

PURPOSE OF FORM – This form provides Re-Entry Services Coalition Members with a written request from the local department of social services to provide services to a SNAP E&T participant who is also an ex-offender.

USE OF FORM – The SNAP E&T worker must prepare the form to refer SNAP E&T participants who are ex-offenders to a Re-entry Services Coalition Member for necessary services.

NUMBER OF COPIES - Two.

DISPOSITION OF FORM – The original form must be sent to the Re-entry Coalition Member for inclusion in the case file maintained at that organization. A copy of the completed form must be maintained in the SNAP E&T file.

TRANSMITTAL #35

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Page 708

Official source

VIRGINIA DEPARTMENT OF SOCIAL SERVICES RE-ENTRY REFERRAL SHEET

10/24 VOLUME V, PART XXV, APPENDIX II, PAGE 42

Local Department of Social Services Re-Entry Client Referral Sheet

FORM NUMBER - 032-03-0412

PURPOSE OF FORM – This form provides Re-Entry Services Coalition Members with a written request from the local department of social services to provide services to a SNAP E&T participant who is also an ex-offender.

USE OF FORM – The SNAP E&T worker must prepare the form to refer SNAP E&T participants who are ex-offenders to a Re-entry Services Coalition Member for necessary services.

NUMBER OF COPIES - Two.

DISPOSITION OF FORM – The original form must be sent to the Re-entry Coalition Member for inclusion in the case file maintained at that organization. A copy of the completed form must be maintained in the SNAP E&T file.

TRANSMITTAL #35