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 2010 Client Referral Form

TO QUALIFY FOR THE SOWER WORK MISSION, the following requirements must be met:

                                      1.  There must be financial need.
                                      2.  The person must own (not rent) the home / property.
                                      3.  It has to be a safe working environment; ie. no attack dogs.
                                      4.  There must be restroom facilities and a place for lunch nearby for the SOWERS.
                                      5.  Deadline for consideration is MARCH 15, 2010.  All parties will be notified by
                                           May 15, 2010.  


        All applications are considered.  Please note the following:
                                      1.  The Epworth Center will select appropriate work sites based on this criteria,
                                           and the gifts and preferences of the registered SOWER groups. We give priority
                                           to mothers with children.
                                      2.  All approved projects are placed online with photos / material lists to be chosen
                                           by SOWERS.
                                      3. The SOWER Work Mission Program typically makes one repair; ie. porch OR
                                           paint house, etc.
                                      4.  Clients need to recognize that SOWER groups are volunteers, not professionals.
                                      5.  Submission of this form does not equate acceptance.
                                       

PLEASE FILL OUT THE FORM IN ITS ENTIRETY, including complete directions to the home.  If you would rather download the form, click here.                                                     updated August 2009.
 
 
Referred By
Agency, Title
Phone Number
Fax
Email
I have received permission from the client to submit his/her name.

 

Potential Client's Name(s)
 
Age     Male   Female
Age     Male   Female
Phone Number
Alternate Phone Number
Street Address
City, Zip

List the name(s), age(s) and gender(s) of children living in the home:

Name         Age         Male   Female
Name         Age         Male   Female
Name         Age         Male   Female
Name         Age         Male   Female
Name         Age         Male   Female

Amount / Materials Available from Client or Sponsor:
         

Detailed directions to home:

What type of home is it?

Trailer One-Story Two-Story Other:

List work needed:

How did you hear about the SOWER Work Mission?

Other:

List any special circumstances:

Enter any questions / comments in the space provided below:

 

    

East Ohio Conference Advance Special Numbers:
9140 - SOWER Work Mission
9191 - Extension Ministries

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