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Advancing the wellness and leadership capacity of Latino populations.
Request for services of Promotor/Promotora
REFERRAL FORM
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.
Avanzando el bienestar y
la capacidad de liderazgo
de la gente Latina.
Please click PDF above to download a physical copy of Promotor/a Referral Form.
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
Personal Information
Location
Contact Information
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