General Sessions Court, Davidson County Social Work Referral Form "*" indicates required fields URLThis field is for validation purposes and should be left unchanged.Client InformationClient Name* First Last Client Case Number(s)*Client Zip CodeReferral InformationReferral Details* Self-Referred Judicial Court Personnel Probation Officer Public Defender’s Office Private Counsel District Attorney’s Office Law Enforcement Agency or Organization Other Agency or OrganizationDetails for OtherReferrer Name* First Last Referrer Phone*Referrer Email* If this is a third party referral, does the client consent to the referral?* Yes No Does client have an upcoming Court Date?* Yes No, I am on Probation No, Other Court Date* Court Time* Hours : Minutes AM PM AM/PM Judge*Please Select....DIV 01 - Judge RobinsonDIV 02 - Judge M. BlackburnDIV 03 - Judge EscobarDIV 04 - Judge WalkerDIV 05 - Judge HayesDIV 06 - Judge Jodie BellDIV 07 - Judge FloydDIV 08 - Judge Rachel BellDIV 09 - Judge JonesDIV 10 - Judge ColemanDIV 11 - Judge HoltCourt RoomProbation Officer*Please Explain*Resources needed (check all that apply)* Housing (permanent/ temporary / shelter/Section 8 / halfway house) Mental Health Services Health Services (including dental) ID/Document retrieval (Birth Certificate /Social Security Card /Driver’s License) Employment TennCARE TANF SNAP SSI/SSDI Help for families & children Domestic Violence Resources Clothing Shower Food (food boxes, warm meals) Alcohol or Substance Use (out-patient, in-patient, AA/NA mtgs) Other Other Resources Needed*Are social work services needed as a requirement of probation or a court order? If yes, explain the specific requirement(s) ordered by the Judge or Probation Officer and the deadline for the requirement(s)?* Yes No Please Explain*Does client have access to transportation in order to receive resources?* Yes No Additional InformationProviding complete and detailed information helps us more effectively assess the client’s needs and determine the ability to provide assistance. If the client is eligible for services, a member of our team will contact the client or referring party within 3 business days.
