Identified below is the information needed to refer an individual to Growth & Opportunity, Inc. for the Skill Building/Work Program. The information is separated into two categories: required and requested. All required information must be obtained prior to the start date. This information will become part of the individual's case file while being served at Growth & Opportunity, Inc.

Required (all referrals):

• Completed Face Sheet - click here* to download
• Release of Information Form - click here* to download
• Person Centered Plan/I.E.P.C.
• Bio-Psychosocial Assessment (as appropriate)
• Behavior Program (as appropriate)
• Information to complete the I-9 - click here* to download

Required (CMH referrals):

• Objectives for appropriate programs
• Signed authorization for Growth & Opportunity to provide skill building assistance


• Psychological evaluation (most current Psychiatric notes)
• Speech & Language Evaluation
• Physical Therapy Evaluation
• Occupational Therapy Evaluation
• Nursing Assessment
• Physical Health Care Appraisal
• Social History
• Previous Work History Information

* This download is in PDF format requires the program Adobe Reader. If you do not have this program, please go to Adobe's website to download it for free.

Revision Date: 2/2012