PRINT THESE THREE (5) FORMS FOR THE WIC:
WIC: Walk-In Log (click on the image above and print)
WIC: Intake Form (for peer counselor to fill out)
WIC: Identity House Deposit Sheet
WIC: Client Information Sheet (for client to fill out)
WIC: Therapist Referral Form NEW!
*PROCEDURE FOR WORKING THE WALK-IN CENTER*
- The new WIC is located at The Center, 208 W. 13th Street.
- The new suggested donation is $25 (but no one is turned away for lack of funds).
- Please note: WIC forms will be available in our locker at The Center, but just in case, you should print out a copy of the forms listed above and bring them with you.
WHEN YOU ARRIVE AT THE CENTER:
1. Go to our locker - #14, small locker to the left of the elevator. Look for the bright orange combination lock. The combination is 7(right), 9 (left), 24 (right)
2. Remove books and forms - Therapist referral and client intake book are in the locker, plus fresh forms will be in a zipper folio. Used forms have their own folder.
3. Hang the WIC sign / “In-session” sign - There are 2 signs. One that says ”Identity House WIC is here tonight” and the other that says you’re “In-Session”. Please hang as appropriate.
4. While you and your co confer about a therapist referral - Once you have seen a client, please have him/her fill out the “Client Information Sheet” when you leave the room to confer about a therapist referral, etc. The client should do this in private and place the completed form in the provided manilla envelope. DO NOT SEAL THE ENVELOPE.
4. Making a referral - New referral slips will be created but for now use the blank cards or sheets of paper.
5. At the end of the night - Place all completed forms in the folder/envelope provided. Keep the WIC sheet on site. Roz will replace it when it’s full.
6. IMPORTANT!!!
*Place money in deposit sheet and envelope with your NAME, DATE, and AMOUNT COLLECTED and place the envelope in the locked box in the locker.
*Don’t forget to make sure the locker lock is LOCKED.
* Please call Identity House at (212) 243-8181 and leave us a message with your name, the number of clients you saw, and the amount of money collected. PLEASE DO THIS BEFORE LEAVING FOR THE NIGHT.
OTHER FORMS
