Module 3 Assignment 1
Module 3 Assignment 1: Resource List for Referrals
Activity Directions
- Fill in all of the missing contact information on the BHA/P List of Resources
- Click here for a Word document containing this form
- Complete you resource list in a word processing program (eg. Word) and save it in the BHA folder you created on your desktop.
- Drag your completed BHA/P List of Resources into the Assignment area to submit it.
Once created, you will have a convenient list of contacts to use when assisting clients. This assignment is also designed to help you become more familiar with the resources available to your clients.
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BHA/P List of Resources |
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Emergency Services |
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Referral Type |
Contact Information |
Contact Information |
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Medical |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Law Enforcement |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Crisis Line |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Other |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Mental Health |
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Referral Type |
Contact Information |
Contact Information |
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Individual Therapy |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Family Therapy |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Mental Health (continued) |
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Group Therapy |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Substance Abuse Treatment |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Local Support Group |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Medical |
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Referral Type |
Contact Information |
Contact Information |
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CHA/P |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Medication Management |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Traumatic Brain Injury |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Nutritional Guidance |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Medical (continued) |
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Other Medical Needs |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Testing and Assessment |
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Referral Type |
Contact Information |
Contact Information |
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Neuropsychological |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Academic |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Speech/Language |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Fetal Alcohol Spectrum Disorder |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Social Services |
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Referral Type |
Contact Information |
Contact Information |
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Transportation Assistance |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Social Services (continued) |
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Head Start/Preschool |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Educational Assistance |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Legal Assistance |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Transitional Services |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Vocational Training |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Subsistence Activities |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Domestic Violence (Shelter/Services) |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
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Sexual Assault Response |
Organization: Contact Name: Phone: Email: |
Organization: Contact Name: Phone: Email: |
You can respond using Word and dragging your file into the response box.
Directions:
1. Download and save the BHA/P List of Resources file to a folder on your computer desktop.
Fill in all of the missing contact information and save your updated resource list.
2. Click on the 'Add Submission'
3. Drag your file into the file area
4. You are able to upload up to 5 files of a maximum size 5 MB each
5. Click 'Save Changes' and you are done!