Pre-ETS School Referral

Pre-ETS School Referral and Student Interest

School District Name(Required)

Referring Staff Member's Name(Required)

Title or Role(Required)

Schools Email Address(Required)

School's Phone Number(Required)

Student Information

Student's Name(Required)

First Last

Date of Birth(Required)

Grade or Transition Program(Required)

Student's Email

Student's Phone Number

Parent, Guardian, or Adult Student Contact

Parent/Guardian's Name

Best Contact Phone No.(Required)

Email Address

Contact Consent(Required)

Does the parent, guardian or adult student agree to be contacted by ADMS?

Referral Readines and Student Interest

Eligibility Documentation Status(Required)

Is the student interested in employment preparation and paid WBLE?(Required)

Has the Student and Family Been Informed About this Referral?(Required)

Brief Reason for Referral(Required)

Known Career Interests, Strengths, or Goals(Required)

Transportation, Accessibility, or Communication Considerations(Required)

Acknoledgement

I understand this is an initial referral only and I must not enter or attach confidential educational or medical records here.(Required)

Submitting this form begins the ADMS referral process. It does not enroll the student or guarantee participation in the ADMS Pre-ETS or paid WBLE program. Before services begin, the student must be referred to and known to New Jersey DVRS, and all required referral documentation and approvals must be completed. DVRS makes final authorization decisions. Participation is also subject to program requirements, available cohort space, and funding.