top of page
donation2.jpg

Referral form
Request services from a promotor/promotora 

A promotor/a is a cultural broker who helps Latinos receive culturally and linguistically appropriate services. They build a bridge of trust between providers and the recipient, which improves outcomes for Latinos and helps the provider better understand the cultural nuances of their families.

​

To submit a referral over the phone, please call: 530-320-5353

Personal Information

Location

Contact Information

Family Members

Family Member 1

Insert information for first family member. If client is a minor, guardian information is required.

Family Member 2

Insert information for family member.

Family Member 3

Insert information for family member.

Family Member 4

Insert information for family member.

Family Member 5

Insert information for family member.

Evaluation

Referring Person

bottom of page