EAST COUNTY MCHRC Grant

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Resources about Mental Health Care and Well Being by Mobile Med and Employment Assistance by CeCg!

Name *

Phone *

Email *

Zip Code *

Preferred Language *

Race and Ethnicity *

Existing (E) or New Referral (N) *

Required

Are You Eligible to Work in the U.S? *

Yes

Not Sure

Documents in Process

Do You Have a MD Driver's License? *

Yes

Non-Driving Identification

Please Specify which Services *

Mental Health Care

Health and Wellbeing

Resume Building and Interview

Employability Skills Training (communication, emails, time management, etc.)

Job Placement

Career Exploration Counselling

Goal Setting

Health Insurance Plan

Have the Information, but don't need the Services at this Point

Other:

Required

Additional Information/ Comments *

Outreach Worker *

Global Community Health Thriving

EDC

CeCg

Required

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