2. Project HIRE: Disability Apprenticeship Program, an apprenticeship program which provides individuals with developmental and/or intellectual disabilities between the ages of 18 and 25 a meaningful paid job training experience within a Prince George’s County Government agency. Participants will be placed within a Host County agency for a period of 9 months and during this time they will have an opportunity to enhance current skills, learn new skills, and gain on the job work experience.
   
   Prior to completing the referral form please to a moment to review Project HIRE’s eligibility criteria:

   • Must be associated with a Supported Employment Provider Agency (ex. DORS, the ARC, Melwood, etc.)
   • Prince George’s County resident with an intellectual and/or developmental disability
   • 18-25 years of age (no exceptions)
   • Available to work Monday through Friday for a maximum of 8 hours
4. Participants Information
6. Date*
   Date
8. Participants Name*
9. Age*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
18. Email Address*
20. Areas of Interest (Check all that apply)*

    1. Data Entry
    2. Copying Documents
    3. Organizing and Distributing Supplies
    4. Caring for Animals
    5. Answer Phones

    1. Account Clerk
    2. Custodian
    3. Receptionist
    4. Filling Documents
22. Referred By
24. Name*
26. Relationship to Participant*
28. Supportive Employment Provider Agency*
30. Phone Number*
31. Email Address*
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field