Bestowing Upon Ministries INC.
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Bestowing Upon Ministries INC.
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Clothes Closet Referral
Please complete the information below to refer an individual or family for clothing assistance services.
Referring Organization Information
Orgainization Name
*
Referring Staff Name
*
Phone Number
*
E-mail
*
Relationship to Client
School Counselor
Social Worker
Teacher
Church Representative
Case Manager
Community Partner
Other
Title or N/A if listerd above
*
Client Information
Client Full Name:
*
Phone Number:
*
Email Address (if available):
*
Preferred Contact Method:
Call
Text
Email
Household Size:
*
Number of Children:
*
Clothing Needs
Who needs clothing assistance?
Infant
Child
Teen
Adult
Entire Household
Urgency of Need
How urgent is this request?
Immediate
Within 3 Days
Within 1 Week
General Assistance
Additional Notes:
Consent & Acknowledgment
I understand clothing assistance is based on availability and donations.
I certify the information provided is accurate to the best of my knowledge.
Submit
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+1-813-445-3503