Submit a Vanderburgh County Referral » uidThis field is hidden when viewing the formCompleted by Client Staff Partner This field is hidden when viewing the formDate of Submission(Required) MM slash DD slash YYYY This field is hidden when viewing the formStatusActiveArchiveThis field is hidden when viewing the formProgress(Required)IntakeIn ProcessCompleted SuccessfullyCompleted UnsuccessfullyThis field is hidden when viewing the formInternal Notes This field is hidden when viewing the formCase Manager- Select -Shaffon BrowderBrittney LaBroiJeannie ReedErica AshfordJamie LangleyLenita BriscoeNichole VestTyrone WilbournAmy SpinksYvonne SmithLynn AdkissonAshton BerrySharon LoveChris CaseltonArmoni TolesAdam WaymireDeagria CookKaitlin Rolli NelsonNova BultmanKaitlin NelsonDarvous ClayRecovery WorksRecovery Works is a program that provides support services to individuals who are involved in the criminal justice system. Recovery Works operates on a voucher-based system and serves as a supplementary funding source until the individual is connected to insurance. At Recovery Works, our focus is on providing customized treatment and recovery solutions to the community. We aim to provide a helping hand to those who are at risk of incarceration or those who are facing legal difficulties. Our goal is to assist individuals in finding the right support and resources they need to overcome these challenges. Before you get started: If you are currently incarcerated, you will be required to have the contact information of a representative from the facility to complete this application. The Recovery Works team will communicate with you through this representative on your intake application. If you have an open case, you are not eligible to use this online system and should contact your criminal justice partner. An open case means you are under supervision with Probation, Parole, Community Corrections, Pre-Trial Supervision or currently incarcerated. If you do have an open case, you will not receive a phone call from the Recovery Works team. Self-Referral Pilot Criteria Participant must be 18 years of age Participant must be a resident of Indiana Participant must have an annual income not exceeding 200% Does not have an open case (no probation, parole, pre-trial, post-trial, community corrections, work release etc.). Prior conviction must have originated in Indiana within 10 years. Individual must receive a referral prior to residing or receiving treatment at an agency PACE will not process referrals for participants who do not meet the pilot eligibility criteria. PACE will not contact individuals who submit a referral who do not qualify for submission. Criminal Justice Partners and/or providers are not authorized to utilize this system and will not receive a response for information submitted. Please continue to utilize the regular process for referral submission. Recovery Works reserves the right to exclude referrals to agencies who do not follow the pilot program criteria. Do I qualify?Please answer the questions below to determine if you qualify for Recovery Works funding.Date of Birth(Required) MM slash DD slash YYYY This field is hidden when viewing the formAgeAre you a resident of Indiana?(Required) Yes No Do you have a current felony charge or prior felony conviction?(Required) Yes No What is the case number?What county is the case in?(Required)- Select -AdamsAllenBartholomewBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushScottShelbySpencerSt. JosephStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitleyHave you been convicted of a misdemeanor?(Required) Yes No What is the case number?What county is the case in?(Required)- Select -AdamsAllenBartholomewBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushScottShelbySpencerSt. JosephStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitleySelect your provider(Required)- Select -Sardis Transitional HousingLife Treatment CentersCall ClinicChoices ConsultingTogether we canNusource Educational ServicesNew Beginnings Recovery CenterDo you have an open case?(Required) Yes No An open case includes pending charges, currently being incarcerated, being on supervision with probation, parole, community corrections, and/or pre-trial supervision. Do you currently have an open DCS/CHINS case?(Required) Yes No Are you currently incarcerated?(Required) Yes No What type of facility?(Required) County Jail IDOC Facility What county?(Required)- Select -AdamsAllenBartholomewBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushScottShelbySpencerSt. JosephStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitleyWhich facility?(Required)- Select -Branchville Correctional FacilityChain O'Lakes Correctional FacilityCorrectional Industrial Facility (CIF)Edinburgh Correctional FacilityHeritage Trail Correctional FacilityIndiana State Prison (ISP)Indiana Women's Prison (IWP)Madison Correctional FacilityMiami Correctional FacilityNew Castle Correctional FacilityPendleton Correctional Facility (IR)Plainfield Correctional FacilityPutnamville Correctional FacilityReception Diagnostic Center (RDC)Rockville Correctional FacilitySouth Bend Community Re-EntryWabash Valley Correctional FacilityWestville Correctional FacilityRelease Date(Required) MM slash DD slash YYYY Are you currently in work release?(Required) Yes No What county?(Required)- Select -AdamsAllenBartholomewBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushScottShelbySpencerSt. JosephStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitleyDo you have housing confirmed once you are released?(Required) Yes No Facility Contact Details(Required)You are required to have the contact information of a representative from the facility to complete this application. The Recovery Works team will communicate with you through this representative on your intake application.This field is hidden when viewing the formQualified You do not qualify at this timeUnfortunately, you do not qualify for the Recovery Works funding at this time. If you would like to see if you qualify for our other programming, please click the button below. Explore Programs You may qualify for Recovery WorksBased on your responses, you may currently qualify for Recovery Works funding. Please complete the form below to register to receive more information.Name(Required) First Middle Last Suffix Jr Sr I II III IV Gender(Required) Female Transgender female Male Transgender male Non-binary Other Pronouns(Required) She/Her/Hers He/Him/His They/Them/Theirs Race(Required) African American/Black American Indian/Alaskan Native Asian Bi-racial Caucasian/White Hawaiian/Pacific Islander Multi-Racial Other Ethnicity(Required) Hispanic Non-Hispanic Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell PhoneOther PhoneEmail Best time to contact you(Required)- Select -MorningAfternoonEveningPreferred method of contact(Required)- Select -PhoneEmailEmployment Status(Required) Employed Part-time Employed Full-time Unemployed Not in the workforce (disabled, retired, etc.) Other What services are you seeking?(Required) Recovery Housing Detox Substance Use Services Mental Health Services In-Jail Services What county are you seeking services in?(Required)- Select -AdamsAllenBartholomewBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushScottShelbySpencerSt. JosephStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitleyWould you like to share any additional information? Criminal Justice Partner InformationA Criminal Justice Partner is an individual directly involved with an individual’s criminal case. Examples of CJPs include: Probation Officer, Parole Officer, Community Corrections Officer, Judge, Court Liaison, Public Defender, Prosecutor, Private Attorney or Jail Staff.Criminal Justice Partner- Select --- Select --Community CorrectionsCourt ServicesIndiana Department of CorrectionsJailParolePrivate AttorneyProblem Solving CourtProsecutor’s OfficePublic DefenderUS ProbationWork ReleaseName First Last Email Phone
