Referral

Referral Form

Promotores are trained paraprofessionals, cultural brokers and, more importantly, trusted resources in the community. They help families navigate the system and access resources; provide translation, advocacy, support and transportation assistance if needed; and assist health care and service providers to deliver care in a culturally meaningful manner. Our promotoras focus on three key areas: Health, Juvenile Justice and Education.

Personal Info
Location
Contact Info

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Family Members
Family Member 1

Insert information for first family member

Family Member 2

Insert information for additional family member

Family Member 3

Insert information for additional family member.

Family Member 4

Insert information for additional family member.

Family Member 5

Insert information for additional family member.

Evaluation

Please be specific as to why you believe this would be an appropriate referral for a promotor/a.

Your Info

Community members can also refer. If no affiliation, just put ‘community.’

Select all that apply

Please call Maria Leon at 916-532-6382 to arrange follow up.

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