Referral - Kitchens For Good

Project Launch Culinary Apprenticeship Program Agency Referral Form

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A hard copy of this form can be accessed at http://kitchensforgood.org/culinary-job-training/ and submitted via email to training@kitchensforgood.org or in hard copy form to 404 Euclid Ave, San Diego CA 92114

If you have not done so already, please have your client complete the Project Launch Culinary Apprenticeship Program Application. Applicants can view program requirements and complete their application online at http://kitchensforgood.org/culinary-job-training/. Hard copy applications can be submitted to the email or physical address provided above. Clients cannot be considered for the program until the application is received.

Once we receive your client's application, we will review it and invite selected candidates for interviews within 1 month of the class start date. Please note that submitting and application does not guarantee an interview or spot in the apprenticeship program. If the candidate successfully completes the interview, he/she will be scheduled to do a 4 hour trial shift in our kitchen. During the trial kitchen shift, candidates will be evaluated on punctuality, ability to follow instructions, ability to focus, team work, and attitude.

All information on this form will be used by Kitchens for Good staff to better understand each potential trainee's abilities, situation, and needs. Information will be kept confidential.

Upcoming Classes

Class Number	Application Due Date	Class Start Date
14	September 3, 2018	October 3, 2018
15	November 12, 2018	December 12, 2018
16	January 27, 2019	February 27, 2019
17	April 8, 2019	May 8, 2019
18	June 17, 2019	July 17, 2019

Online Referral

Referrer Agency Information

Referrer First Name

Referrer Last Name

Referrer Title

Agency

Preferred Phone

Work

Mobile

Work Phone

Do not enter dashes or special characters; only use alpha or numeric characters

Mobile Phone

Do not enter dashes or special characters; only use alpha or numeric characters

Street Address

City

State

Zip Code

General Referral and Client Information

Referral Date	Referral for Class Number
Client First Name	Client Last Name
Client Phone Do not enter dashes or special characters; only use alpha or numeric characters	Client Email

Referrer and Client Relationship Information

Reason for Referral

Why is the Client Under Your Care

How Long Have You Been Working Together

How Often Do You Communicate

How Often Do You Meet

What Other Agencies Do You and Your Client Collaborate With

What Are the Client's Short Term and Long Term Goals

What Are The Client's Current Challenges

What Challenges Do You Have With the Client

Anything Else We Should Know

Does Your Client Earn Less Than $20,450 Per Year (Low Income Status According to HUD)

If No, What is Their Annual Income

I Hereby Certify That the Above Information Regarding Client's Income is Truthful Based on My Knowledge and Experience Working With the Client.

Name

Signature

Continued Collaboration, Client Attendance, and Signature

Kitchens for Good Culinary Apprenticeship Program will not take the place of any social service agency the client is/will be utilizing. Are you willing to maintain collaborative support (maintain and open line of communication, attend meetings, etc.) with Kitchens for Good to promote the overall well-being of the client?

Are there any restrictions that would prohibit/interfere with the client's ability to participate Monday through Friday from 8:30am - 430pm?

Specify attendance time restrictions (day and time)

Signature

Date

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﻿Project Launch Culinary Apprenticeship Program Agency Referral Form

Project Launch Culinary Apprenticeship Program Agency Referral Form