Please consider the following PRIOR to completing this online application.
Each referring agent must have a valid business email address (this will identify you in our system) and internet access. We do not accept personal email accounts such as Gmail, Yahoo, AOL, Comcast, etc. nor do we accept shared email accounts.
A referring agent must be a licensed social worker, counselor or case manager that works one-on-one with the clients they serve as defined by their job. Home visits by you, the referring agent, prior to making referrals may be required.
ACCEPTANCE IS NOT GUARANTEED. ALL APPLICATIONS ARE REVIEWED AND A CONFIRMATION WILL BE EMAILED IF THE APPLICATION IS APPROVED.
General Agent Information
Are you a professional in the social service field and want to make referrals for your clients?
Our approved referring partners have the ability to refer their clients to receive much needed furniture, clothing and household items with a minimal access fee (if applicable). Our staff and volunteers work hard with our community of donors to provide the best service possible - with pride and dignity. Explore the information provided below to determine if you qualify as a potential social service partner.
The contact information provided is never shared, sold or used for any other purpose than the consideration of this application.
The only additional option will be our optional public partner agent directory, which will require your express permission (see below).
Agency/Organization Name:
Mailing Address - Street:
City:
State:
Zip Code:
County:
Specialized Area of Professional Focus
County, NOT Country
Select All That Apply
This information allows us to provide the best external help to a client when necessary.
This information is also used in our public professional directory if you choose to be listed.
If none of the above:
Direct Service Background / Area Served
What Year did you begin with your current employer?
Primary way of assessing a client’s need?
This information helps us to better understand the level of service and service area that will be impacted through your referrals.
Do you perform home visits for the clients you need to refer?
What counties do you serve? Select all that apply
Other Primary County:
Tell us about your agency/organization or area of focus, etc.
What do you require to confirm clients qualify for your services? Select all that apply
This applies to qualifying for your services, not just a referral to Sharing Connections services.
Does your agency pay the client’s access fee?
Does your agency assist in providing transportation of the items?
What is your agency/organization 501c3 number (if applicable)
As part of the service we provide, we may make available a list of partner agents with contact info, for clients in need of other services in the community. This could potentially include your name, phone number, agency name and area of service. You are not required to participate in having your information publicly available to potential clients and this will not affect your ability to refer clients to our services.
Would you like your information to be available to potential clients in need of additional services?
Final Step - Acceptance of Service Agreement
You must agree to all the terms listed below:
I understand that my position must be a counselor, social worker, crisis manager, case manager or in that related field working directly with families in crisis as defined by my current job.
I understand that I must accurately assess the client's furniture needs and only request furniture the client currently does not have.
I, the approved referring agent, agree NOT to share this training manual or any information that is accessible through the online referral system with any individuals (including the client). This information is to be treated as confidential and only accessible by SC and the referring agent. This includes all references to the Referral ID # provided per the online system. Providing this number (through conversation, printed screen shots, printed materials) to a client gives them direct access to the online referral where updates can be posted under your name.
I agree that I WILL NOT submit referrals on behalf of co-workers under my name. I understand that it is my responsibility to only refer clients that are working directly with me. Sharing an account or submitting a referral on behalf of a co-worker will result in the immediate closure of the referring account without notice. The account will not be reopened.
I can confirm that my organization, qualifications for services and services provided do not discriminate on the basis of Color, National origin, Religion, Sex, Disability, Age, Marital status or Sexual orientation.
By entering my name below, I am agreeing to all the terms listed above.
Submit Full Application
Once you select the Submit Application button below, your information will be submitted for review. You will be notified once the referring account is approved.