Skip to main content
Find out more about our Covid-19 Plan.
Donate
Home
Interested in Our Services
Who We Are
Mission & History
Board of Directors
Meet Our Leadership Team
Careers
Service Regions
Contact Us
CARF Accreditation
What We Do
Program Services
Business Solutions
PHASE-Industries Owned Businesses
Heritage Thrift
Heritage Barnwood
News & Events
Blog
Event Calendar
Join Our Mailing List
Phase-Industries North
PO Box 126
106 Main Street
Sandstone, Minnesota 55072
Phone
(320) 245-2246
Contact
Phase-Industries South
23385 Freeway Blvd.
Pine City, MN 55063
Phone
320.629.7805
Fax
320.629.0025
Contact
Heritage Home Creations
23385 Freeway Blvd.
Pine City, MN 55063
www.heritagestores.org
Phone
320.333.7210
Contact
Donate
Menu
MENU
Interested in our services? Fill out this form.
Participant Information
Name
First Name *
Last Name *
What town do you live in?
Phone Number
Email
Vocational Rehabilitation Counselor (if applicable)
Counselor Name
Phone Number
Email Address
Guardian Information
Guardian
None/Self
Private/Family Guardianship
Counselor Assigned
Ward of the State
Guardian Name
Phone Number
Email Address
Case Manager Information
Case Manager Name
dpijacorg18o
Case Manager County
Phone Number
Email Address
Residential Contact Information (if applicable)
Residential Contact Name
Residential Contact Phone Number
Residential Contact Email
Desired Services
Select Desired Service Type (Check all that you are interested in)
Exploring employment options
Finding employment
Planning for employment and benefit management
Job retention skills training and development
Pre-Employment training for Transition Age Students - ages 14 to 21
Post-Secondary education counseling
Work place readiness skills training and development
Pre-Vocational skills trainings and development
Day Services (Previously DT&H)
Select the level of support that best fits your needs:
Fully Independent
Mostly Independent - need minimal support from others
Somewhat Independent - rely on regular support from others
Dependent upon an active daily plan of support to be successful
All areas of my life require support from others
Primary Diagnosis
Developmental Disabilities
Mental Health
Autism
Down Syndrome
Traumatic Brain Injury
Physically Disabled
Other
Secondary Diagnosis
Funding Type
Waiver Funded
VRS
County Paid
CDCS
Self pay
Current or recent day program/employer (indicate N/A if no prior work experience)
Reason for desired change/Description of prior work experience (if applicable)
This form needs Javascript to display, which your browser doesn't support.
Sign up here
instead
Home
Interested in Our Services
Who We Are
Mission & History
Board of Directors
Meet Our Leadership Team
Careers
Service Regions
Contact Us
CARF Accreditation
What We Do
Program Services
Business Solutions
PHASE-Industries Owned Businesses
Heritage Thrift
Heritage Barnwood
News & Events
Blog
Event Calendar
Join Our Mailing List
Get Involved
Donate Now
Upcoming Events
Get Our Newsletter
Close Menu