Are you a case manager or support professional? Carroll’s Kitchen offers paid employment, culinary training and wrap-around support for women overcoming addiction, homelessness, incarceration, domestic violence and other crises. Here is how a referral works.

Who the program is for

Women who are ready for a physically demanding full-time workday and prepared to work on the barriers that have made lasting change difficult. If the program is not the right fit right now, our team helps find one that is.

Questions before you refer?

Referral form

This form is for case managers and support professionals. If you are a woman interested in the program for yourself, please ask your case manager to refer you, or call us and we will help you find the right next step.

About you

Referring organization (required)

Your first name (required)

Your last name (required)

Your phone number (required)

Your email address (required)

About your client

Client's first name (required)

Client's last name (required)

Client's email address

If she has one. We will contact her through you if not.

Client's phone number

Is it safe for us to leave her a voicemail or text?

We ask about everyone. It is never assumed.

Yes No, contact her through me Not sure

Eligibility (required) She is 18 or older

Consent (required) My client knows about this referral and has agreed to me sharing this information with Carroll's Kitchen, and to Carroll's Kitchen contacting her.

Your referral

How long have you known your client, how often do you interact, and in what circumstances? (required)

Share a brief history of your client, and why you think she would be a good fit for Carroll's Kitchen. (required)

Please leave out medical diagnoses and details of any offence. We will talk through anything else in person.

Can your client lift up to 50 lbs and be on her feet for 6–7 hours? (required) Yes No Not sure

Does your client have reliable transportation to arrive by 7 AM, Monday through Friday? (required) Yes No Not sure

Supporting document (optional)

A signed release of information, or the paper assessment if you have already filled it in. You can still complete the assessment below.

PDF, JPG or PNG. Up to 8 MB.

Stability Program Assessment

Tick every line that is true for your client today. The score adds up as you go; you do not need to calculate it. Lines marked "noted" are for our information and do not change the score.

Food

Food access Lives in a food desert 0 pts Uses a food pantry network 2 pts Has the means to cook fresh food where she lives 5 pts

SNAP benefits (choose one) Not eligible for SNAP noted Eligible for SNAP but not receiving it 0 pts Receiving SNAP 3 pts Income has increased beyond SNAP eligibility noted Not known / skip

Housing

Housing history Has a history of housing insecurity noted

Where she lives now (choose one) No address (homeless) 0 pts In a shelter 1 pt In a motel 1 pt Shared dwelling, not on the lease 2 pts In a trusted transitional home 3 pts Shared dwelling, on the lease or has her own lease 4 pts Independent housing with her own lease, rent under 30% of income 5 pts Owns her own home 5 pts Not known / skip

Healthcare

Health coverage (choose one) No healthcare coverage 0 pts Medicaid or Medicare 3 pts Marketplace healthcare plan 5 pts Private health insurance 5 pts Not known / skip

Care she is using Has WIC 3 pts Established patient at Neighbor Health, Advance, or DHHS 5 pts Receiving mental health care on a regular basis 5 pts Has acknowledged a mental health history noted

Finances

Banking (choose one) No bank account 0 pts Checking account shared with someone else 3 pts Her own checking account 5 pts Not known / skip

Financial steps Direct deposit set up with Carroll's Kitchen 5 pts Has accessed her credit score 3 pts Completed an external budget sheet 3 pts Actively uses a budget sheet 5 pts Paying back medical debt 4 pts Paying back DMV fines 4 pts Paying back student loans or getting out of default 4 pts

Transportation

Getting to the grocery store (choose one) Walks 2 pts Takes the bus 3 pts Drives 5 pts Not known / skip

Bus commute (if she takes the bus) (choose one) Generally no stops on the route 4 pts Generally 2 or more stops on the route 2 pts Not known / skip

Other transportation Can walk or bus to affordable healthcare 5 pts Has a driver's license 5 pts Owns a car and has insurance 5 pts

Justice system

Court fines (choose one) More than $5,000 in fines 0 pts Less than $2,500 in fines 2 pts Less than $1,000 in fines 3 pts All fines paid 5 pts No fines / not applicable noted Not known / skip

Other Has re-entered the justice system 0 pts Voting rights restored, or has re-registered to vote 5 pts

Relationships

Phone (choose one) Has a cell phone 5 pts Does not have a cell phone 0 pts Not known / skip

Healthy relationships (choose one) No healthy relationships 0 pts Healthy relationships are out of reach 0 pts Has healthy relationships, but far away 3 pts Has 3 or more healthy relationships nearby 4 pts Sees 3 or more healthy relationships daily or weekly 5 pts Not known / skip

Her circle People close to her use drugs and are not in recovery 0 pts People close to her have experienced addiction and are in recovery noted People close to her are experiencing housing insecurity 0 pts People close to her were housing insecure and are now stably housed noted

Community

Common-interest community group (choose one) No community group 0 pts Takes part monthly or less 3 pts Takes part weekly 5 pts Not known / skip

StepUp / Jobs for Life (choose one) Has never attended 0 pts Currently enrolled 3 pts Has completed it 5 pts Not known / skip

Assessment score so far: 0

What you send goes to Carroll's Kitchen and nowhere else. It is encrypted, read only by program staff, used only to consider this referral, and deleted on a schedule.