Get Manitoba Service Provider Participant Intake Form

Filling out the Manitoba Service Provider Participant Intake Form online is an important step in the service provision process. This guide will provide you with step-by-step instructions to complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the project information section. Fill in the file number, service provider name, project name, and the service provider's ETS-ICM case number. Also, include the participant's start date and projected end date in the required format (yyyy/mm/dd).
3. In the participant identification section, enter the social insurance number followed by the participant's name, including first name, middle name, and last name. Record the date of birth and select the appropriate gender identity option.
4. Choose the preferred language and language of service from the options provided.
5. Identify the referral source by selecting one of the options listed. This helps to understand how the participant was referred to the service provider.
6. Fill in the primary contact information. Enter the residential address, delivery address, city/town, postal code, telephone number, alternate number, and email address in the corresponding fields. If necessary, provide additional information for the address.
7. If applicable, complete the alternate contact information section similarly to the primary contact information.
8. In the demographic information section, indicate the employment status at intake. Specify if the participant is employed, unemployed, or self-employed, and provide details regarding wage, hours per week, and payment frequency.
9. Fill out the education section, including the highest level of education completed and the year education was completed.
10. Indicate if the participant is currently receiving employment insurance benefits and if they are receiving income assistance benefits. Specify the source and status of income assistance as necessary.
11. Complete the indigenous status, marital status, dependent information, and disability inquiries as applicable.
12. If applicable, indicate whether the participant belongs to a visible minority or is an immigrant/refugee. Provide the landing date if relevant.
13. Once all sections are filled out, review the entire form for accuracy. Users can then save changes, download, print, or share the completed form as needed.

Complete the Manitoba Service Provider Participant Intake Form online to ensure a smooth service provision experience.