Thee Hand of God

We Are Prophetic, We Are Apostolic, We Are Thee Solution Hand of God

    SECTION A - Referrer’s Information
    First Name
    Last Name

    Organizational Affiliation
    Role/ Position

    Email
    Contact #

    SECTION B - Referee’s Information
    First Name
    Last Name

    (DOB) Age
    Gender

    Ministry Affiliation
    Relationship to Referrer

    Address:
    Street/ Apt
    District

    State/ Parish
    Country
    Postal/ Zip Code

    Email
    Contact #

    SECTION C - Referee’s Profile
    Employment Status
    Relationship Status

    Number of dependents
    Health Status - Are you currently on prescription medication? (Please list any chronic illnesses you have.)


    Social Support Network On a scale of 1-5, how would you rate your social support system; 1= no support, 2=sporadic support, 3=very little support, 4=some support and 5=consistent support
    Type of Support Needed

    Highest Level of Education Completed
    Highest Certification Received
    Housing Status

    SECTION D - Additional Details
    Write a brief overview of the referee’s situation, including any details that justify your referral (N.B. - Information will be verified)

    SECTION E - DECLARATION
    DECLARATION


    Signature

    Date

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