Individuals Seeking Services

Alternatives Inc - dignity through independence

Last Name
First Name
Address
City
State
Zip Code
Preferred method of contact
E-Mail
Phone Number
VP Number
Fax Number
Relationship to person seeking services:	Self Family Member Other
Are you currently receiving services from another organization?	Yes No
Which organization?
Do you have a case manager with any of these organizations? (check all that apply)	DDD Mental Health Agency DVRS Other:
Reason for seeking services: (check all that apply)	Developmental Disability Mental Illness Deaf Hard Of Hearing Homeless Other:
Type of services you are seeking: (check all that apply)	Support Services Employment Transition Housing Other:
Is there any additional information that you would like to share?
If you have a developmental disability and are seeking support services from Alternatives, Inc. you must have a case manager with the Division of Developmental Disabilities (DDD). To learn more about DDD go to http://www.state.nj.us/humanservices/ddd/home/index.html To be eligible to receive services through Alternatives, Bridges to Employment program, you must have a counselor at the Division of Vocational Rehabilitation Services (DVRS). To learn more about DVRS go to http://lwd.dol.state.nj.us/labor/dvrs/DVRIndex.html If you have a mental illness and are interested in Permanent Housing and Case Management services or if you are in a homeless situation with or without mental illness and receive General Assistance, TANIF or Social Security Insurance please complete the COMMUNITY OUTREACH SERVICES APPLICATION.