Massachusetts Department of Developmental Disabilities Employment First Technical Assistance Center Consultant Referral Form Technical assistance is being

made available to service providers funded by the Massachusetts Department of Development Disabilities (DDS) to assist in transforming service delivery resulting in expanding the number of individuals in integrated employment while reducing and eliminating the use of sheltered workshop services. To support this technical assistance effort the !nstitute for "ommunity !nclusion at #Mass $oston (!"!) is currently building a pool of %ualified consultants to supplement its own staff who can provide comprehensive technical assistance or serve as sub&ect matter experts on key issues related to the transformation process. !"! is seeking recommendations for consultants and sub&ect matter experts including but not limited to current service providers in M' who have the expertise needed to provide comprehensive consultation and(or targeted technical assistance in key areas. )ecommendations may include individuals from both inside and outside Massachusetts. "onsultants will be compensated for their time. To recommend a consultant or sub&ect matter expert please complete this "onsultant )eferral *orm and email it to David +off at david.hoff,umb.edu. -roviders who have expertise and availability are welcome to self.refer. I am recommending the following individual as a consultant to assist service providers in Massachusetts to transform their services to e pand integrated employment and reduce!eliminate use of sheltered wor"shop services# $ame %rgani&ation Address '(treet) City) (tate) *ip+ ,hone $umber Email -ebsite

Final Consultant Referral Form: November 2013

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,lease indicate the specific areas of e pertise and!or sub.ect matter this consultant would be able to assist service provides with in their transformation process#

,lease indicate why this consultant is /ualified to provide consultation and e pertise on the areas indicated in the response to the /uestion above#

Contact Information for Individual Ma"ing Recommendation (if self.referral leave blank) (taff ,erson Ma"ing Recommendation %rgani&ation $ame ,hone $umber Email

Final Consultant Referral Form: November 2013

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