Loading...
Blue Header
  • Home       Request More Information
  • About PHFS
    • History
      • Pictorial History
      • Photo Gallery
    • Mission & Vision
    • Alumni
    • Board of Directors
    • Facilities
    • FAQ
    • In the News
    • Publications
      • Annual Report 2011
      • Bulletin
    • Careers
    • Register
  • Programs & Admission
    • Children's Programs
      • Therapeutic After School
      • Therapeutic Foster Care
      • Photo Gallery
    • Adult Programs
      • Group Home Services
      • Supervised Living Services
      • Sponsored Home Services
      • Referrals
      • Photo Gallery
    • Little Wings Preschool
      • About Our Programs
      • Research Based
      • Summer Camp
      • LW Application
      • Registration Form PDF
      • Registration Form MSWord
      • Photo Gallery
    • Community Based Services
      • Child Care Resource Center
        • Child Care Trainings Listing
        • Child Development Associate (CDA) Class
      • Counseling Center
      • Credit Counseling
      • Family Partnership
      • Food Pantry
      • Healthy Families
      • Intensive In-Home Services
      • Nurturing Programs
      • Partnership Prevention of Substance Abuse
      • Supportive Services
      • Vehicles for Change
      • Ways to Work
  • Volunteer
    • Photo Gallery
    • Volunteer Information Form
  • Giving
    • Give Online Now
    • Planned Giving
    • Donate by Mail
    • Give Stocks and Securities
    • Matching Gifts/Workplace Giving
    • Donate In-Kind Gifts
    • Donate Door Prizes
    • Development Staff
  • Events
    • Events Calendar
    • Turkey Trot
    • National Family Week
    • Toy Run
    • Executive Spelling Bee
    • Community Resources Conference
    • Poverty Simulation - A Day in Their Shoes
    • Day in the Country
    • 5K and Youth Run
    • Homecoming
    • Previous Events
  • Careers
    • Fredericksburg
    • Lexington
    • Lynchburg
    • Therapeutic Foster Care
    • Richmond
    • Zuni
  • Contact
    • Administrative Office
    • Childrens Services
      • Childrens Referral
    • Adult Services
      • Referrals
    • Request More Information
Programs and Admissions > Adult Programs > Referrals
  • Make a Secure Donation!
  • Log In
Loading...
Make a Donation!

Menu 30 Begins - Skip Menu

  • Children's Programs

    • Therapeutic After School
    • Therapeutic Foster Care
    • Photo Gallery
  • Adult Programs

    • Group Home Services
    • Supervised Living Services
    • Sponsored Home Services
    • Referrals
    • Photo Gallery
  • Little Wings Preschool

    • About Our Programs
    • Research Based
    • Summer Camp
    • LW Application
    • Registration Form PDF
    • Registration Form MSWord
    • Photo Gallery
  • Community Based Services

    • Child Care Resource Center

      • Child Care Trainings Listing
      • Child Development Associate (CDA) Class
    • Counseling Center
    • Credit Counseling
    • Family Partnership
    • Food Pantry
    • Healthy Families
    • Intensive In-Home Services
    • Nurturing Programs
    • Partnership Prevention of Substance Abuse
    • Supportive Services
    • Vehicles for Change
    • Ways to Work
Menu 30 Ends
Loading...
Loading...
Loading...
Share |
Loading...

Now united with
the Family Alliance

 

family alliance 160

Loading...
Interact With Us! 

Facebook

YouTube

Twitter
Loading...

Request more information and get involved.

Loading...
Zuni

Adult Referral

Individuals in the Adult Services Programs must have a primary diagnosis of an intellectual disability and must be 18 or older. The individuals must not be abusing any substance or engaging in any homicidal, suicidal or illegal activities. If you would like to speak to someone regarding the admission process, please call (434)-384-3131, ext. 3622 or ext. 3643.

Or you can fill out the information below and someone in our Adult Services Office will contact you about the admissions process.

First Name:
Middle Initial:  
Last Name:  
DOB  
Gender

Does this individual have a diagnosis of an intellectual disability?

 
Married:
Pregnant?
Referral Source: Name:  
Relation:  
Address:  
Phone:  
Email:  
     
Primary Family Contact Name:  
Relation:  
Address:  
Phone:  
Email:  
     

Legal Guardian/ Authorized Representative:

Name:  
Relation:  
Address:  
Phone:
Email:  
     
Does the person have a Case Manager/Support Coordinator at the CSB? 
If Yes, Case Manager/ Support Coordinator Name:  
Address:  
Phone:
  Email:  
What program is the invidual interested in?
 
Where does the individual want to live? (check all that apply)
Payment Source: (check all that apply)  
Where does the individual live currently?
Comments/ Questions  
  

 

Loading...
  • Services 
  • Make a Referral
  • Giving Options
  • Photo Gallery
  • Employment
  • Privacy Policy
  • Zuni Gourmet Peanuts
  • Site Map

© 2010 Presbyterian Homes and Family Services

  • 150 Linden Avenue
  • Lynchburg, Virginia 24503
  • Phone: 434-384-3131