Required Documentation

Required Documentation
Individuals being referred to STAR Council for Substance Treatment are required the submit each a Photo ID, Proof of Residency, Proof of Income, and Incurance (if applicable).

These documents must be submitted prior to getting an appointment scheduled.

Submission Instructions:
- Take photos in well-lit areas, information must be visable and clear.
- Take photos on a flat surface. DO NOT hold the card in your hand.
- Document photos should fill the whole viewing area.
Todays Date*

MonthDayYear
Date
Name*

First NameLast Name
What STAR Council location are you interested in?*
Photo ID
Upload your Photo ID HERE

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(Driver's License, Passport, or Identification Card are all acceptable.) Cancelof
Is your primary address different from what is on your photo ID?

NoYes

Proof of Residency

Only for Substance Treatment
Please upload a photo of a Utility Bill for the address where you live or stay.

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Are you currently homeless?

NoYes, I am staying at a shelter.Yes, I am staying with a friend/family member, while I find a place.Yes, other.

Residency Letter

Temporary
Date:

MonthDayYear
Date
I,first and last name, as the client to receive services, am currently residing withwho I am staying with temporarily (name of family, friend , etc.) at the following address.
Address I will be at less than 6 months.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By my signature, I am attesting to the information on this page and its accuracy.

Clear

Proof of Income

Only for Substance Treatment
ALL working adults, living in the household, are required to provide proof of income.

It is possible that the State of Texas will cover the all program cost for the individual seeking treatment.
Are you Currently Employed, where you receive a paystub or tax return?

YesNo

My Proof of Income (paystub, income tax return) Uploaded HERE

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My spouse or household members proof of income. Uploaded HERE.

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Cancelof

Unemployment Attestation
Date:

MonthDayYear
Date
I,First and Last Name, as the client to receive services, have no form of income at this time. I am receiving help from Name of person that helps me .
The above name individual helps me financially by...
How do they help? Be as detailed and specific as possible.
Person helping you: Upload an image of their check stub or W2

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By my signature, I am attesting to the information on this page and its accuracy.

Clear
Are you currently looking for employment?

YesNo

Employment Attestation

Cash Payment
Date:

MonthDayYear
Date
I, First and Last name, as the client to receive services, am currently employed withCompany Name( employer) as what do you do? and receive cash payments only.
I First and Last name receive $Amount per pay period. I am paid on a: weekly, bi-weekly, monthly cycle.
By my signature, I am attesting to the information on this page and its accuracy.

Clear

Is there anything else you want to submit? i.e. court documents or a family plan

NoYes

Photo ID