One Stop Partner Referral Form
Please complete and submit this form to refer an individual to One Stop partners.
Referring to
*
Please Select
IDES - Illinois Dept. of Employment Security
IDHS - TANF
IDHS - Vocational Rehabilitation
KCCSI - Kankakee County Community Services Inc.
KCC Adult Education
KCC Workforce Services
KCC Continuing Education
Which partner are you referring the individual to?
Your name
*
First Name
Last Name
Referring from
*
Please Select
IDES - Illinois Dept. of Employment Security
IDHS - TANF
IDHS - Vocational Rehabilitation
KCCSI - Kankakee County Community Services Inc.
KCC Adult Education
KCC Workforce Services
KCC Continuing Education
KCC Office of Disability Services
Which partner is making the referral?
Your email
*
example@example.com
Your phone
*
Please enter a valid phone number.
Phone ext.
(Optional)
Referral's name
*
First Name
Last Name
Referral's email
*
example@example.com
Referral's phone
*
Please enter a valid phone number.
Phone ext.
(Optional)
Referral's primary language
*
Tell us about your referral
*
Consent
*
I have permission from the referred individual to share the information listed above with the referral organization.
Email a copy
If you want a copy of your submission please enter an email address to send it to.
Please verify that you are human
*
Submit
Should be Empty: