A Decrease font size.
A Reset font size.
A Increase font size.
If you or your student is interested in participating in CLW’s Pre-Employment Transition Services (Pre-ETS) program, please fill out the Referral and Consent Form. If you have any questions on the form or would like a hard copy of this form, please contact Courtney Cormier, Pre-ETS Skills Trainer at firstname.lastname@example.org. Filling out this form does not guarantee enrollment. This form is HIPPA compliant and encrypted.
I am requesting Pre-Employment Transition Services based upon the criteria that I am a student with a disability.
I understand I will need to meet with a Pre-ETS Provider and develop a service plan that will be approved by
MRC before I start receiving services. I understand that, as a recipient of services from MRC, I have the right to
seek advocacy services from the Client Assistance Program (CAP) at 1-800-478-1234 or http://www.dlc-
For the specific purpose of participation in Pre-Employment Transition Services, I grant permission for the
service provider to exchange information with the schools, authorized personnel, and MRC to verify services
were provided to me.
Center for Living & Working | 484 Main Street Suite 345, Worcester, MA 01608
Voice: 508-798-0350 | Toll Free: 1-800-570-4020 | TTY: 508-755-1003 | Video Phone: 508-762-1164 | FAX: 508-797-4015
© 2020 Center for Living & Working.
All Rights Reserved. Website Design.