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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.

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

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Un/a promotor/a es un intermediario cultural que ayuda a las personas latinas a recibir servicios culturales y lingüísticamente apropiados. Construye un puente de confianza entre los proveedores y los beneficiarios, lo que mejora los resultados para la comunidad latina y ayuda al proveedor a comprender mejor los matices culturales de sus familias.

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​Para enviar una referencia por teléfono, llame al: 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

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