Referral Application


With questions, please contact Samantha Menke by phone at 712-539-8067 or e-mail at:


  • Complete and submit the application on this page (Download a .pdf of the referral application here)

  • Admission committee reviews application and supportive data

  • If application is approved, funding source is identified

  • The Pride Group contacts individual if there is an available opening

  • Tour The Pride Group facilities


  • Individual is 18 years of age or older

  • Individual has an intellectual and/or developmental disability, mental health diagnosis, or a brain injury

  • Individual is not a danger to self or others

  • Individual is medically stable and does not require 24-hour nursing care

  • Individual has a funding source to pay for services

  • Individual will benefit from The Pride Group services

Today's Date
Today's Date
Member Name *
Member Name
Member birthdate
Member birthdate
Does this member have a current established payee:
Does this member have a legal Guardian?
Does this member have a Case Manager or IHH Worker?
Does this member have any outstanding fines or child support issues?
Please indicate which location(s) you may be looking into for services for this member:
Your Name *
Your Name