Referral Form

Completing the referral form:

It is essential that the referral form be completed accurately and completely. Without complete and accurate information, it is possible that an individual who is eligible for the project could be determined ineligible and, thus, would not benefit from the project's services. In addition, the project is required to send yearly reports that require complete information for each individual involved with the project. (This information is submitted without the individual's name.) Call 784-6471 in the Reno area, or our statewide toll-free number 1-877-621-5042 with any questions regarding this referral form.

This form is only available by downloading it from the "Printable NDSIP Referral Form" link below. You will need Adobe Acrobat Reader to view this form.

Printable NDSIP Referral Form

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