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AGENCY REFERRAL FORM 2018-03-27T16:07:18+00:00

THIS FORM IS FOR COMPLETION BY REFERRING AGENCY ONLY

In order to ensure that your referrals receive prompt consideration, please ensure that Clay County Clothes Closet digital referral is completed in full before you submit. We will not be able to accept or schedule referrals for clients with incomplete or omitted information.
Following your form submission, a CCCC appointment scheduler will email you a  date and time for your client’s clothes fitting appointment. This correspondence will be directed back to the Referring Agency/Agent contact on the referral.

AGENCY REFERRAL FORM

If you have any questions or comments regarding our online submission process, please contact us before submitting your referral. We are happy to clarify any questions you might have about this process.
Some older browsers may not be compatible with this web form. Please use the provided pdf form instead.

Download copy of our Legacy PDF Form here for submission via fax or email.