Service Provider Referral Form−This referral form is intended for service providers to connect clients with appropriate programs, services, or supports.Submission of this form does not guarantee program acceptance.For questions regarding this form or the referral process, please contact clientinquires@prospectnow.ca or 1-877-483-2562.When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.Referral InformationReferring Agency / OrganizationReferral Worker NameReferral Worker EmailReferral Worker PhoneDate of ReferralNextClient InformationClient NameEmail AddressPhone NumberDate of BirthClient's preferred method of contact* Phone Email TextCity / Municipality of ResidenceGuardian Nameif applicableGuardian Phone Numberif applicableBackNextClient Goals, Interests & Support NeedsWhat is the client seeking support with?*Check all that apply Creating job search tools (e.g., résumé, cover letters, interview preparation) Career Advising Job Search Support Attending job preparation workshops Engaging in training or education program Learning how to maintain employment/retention services Attending employer networking events or job fairs Starting their own business / self-employment Gaining work experience OtherWhat is the client seeking support with? (Other)Is there a specific Prospect program the client is interested in engaging with?Leave blank if there is no preference and open to recommendationsDoes the client have an intended job target they would like to pursue? (e.g, construction, customer service, etc.)BackNextEligibility & Participation ReadinessIs the client 18 years of age or older?* Yes NoIs the client currently unemployed or underemployed?* Yes NoIs the client legally entitled to work or train in Canada?* Yes NoIs the client a Canadian citizen, permanent resident, or person with conferred refugee status?* Yes NoDoes the client self-identify as having barriers that may impact participation (e.g., mental health, disability, social or systemic barriers)?* Yes NoIf yes, please describe the barriers and/or support needs (as disclosed by the client)BackNextAvailability & CommitmentIs the client available to participate in programming (virtual, in-person, or at-home)?* Yes NoApproximate weekly availability* Less than 10 hours 10–12 hours 12+ hoursIs the client interested in working toward employment (12+ hrs/week) or further education within the next 3–6 months?* Yes NoIs the client currently receiving Employment Insurance (EI)?* Yes NoPlease share any additional information that may support appropriate service matchingBackNextConsent & ConfirmationI confirm that the client is aware of and consents to this referral and the sharing of relevant information for the purpose of service connection.* Yes NoBackNextAuthorization to CommunicateIs the referring service provider authorized by the client to speak further on their behalf regarding this referral?* Yes – the client has provided consent No – please communicate directly with the client Limited – consent is specific to the following topics OtherIs the referring service provider authorized by the client to speak further on their behalf regarding this referral? (Other)If yes or limited, please indicate the preferred contact for follow-up Referring service provider Client directly BothIf Limited, consent is specific to the following topicsBackSubmit ReferralThis site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.