make a referral

We only accept referrals submitted by case managers of agencies that serve women in crisis. Please take a moment to read about our hiring process and qualifications before writing a referral. If you feel your client would be a good fit for our Restorative Employment Model, let’s begin with this confidential referral. Once you submit it, we’ll be in touch.

Referring Organization

Your Name

First Name

Last Name

Referring Organization

Your Email Address

Your Phone Number

(###)

###

####

Client/Applicant Information

Client's Name

First Name

Last Name

Client's Phone Number

(###)

###

####

Client's Email

Client's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tell Us More About Your Client

Please tell us how long you’ve known your client, how often you interact with them, and under what circumstances.

Please share a brief history of your client and why she would be a good fit at Carroll’s Kitchen.

Please share your client's current status in the following categories:

Food - Does your client have access to three healthy meals a day?

Housing - Where is your client currently living?

Transportation - Does your client have reliable and safe transportation?

Relationships - Does your client have access to healthy friends and mentors?

Future Planning - What are your client’s one year goals?

make a referral

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