Referral to CEF (Durham Office)
Before Making a Referral: If you know someone who might be a good fit with CEF, please ask if they would be willing to share their contact information with CEF. We will reach them directly to find out what they're interested in, share how CEF might fit their interests and goals, and schedule a meeting with them during our office hours.

If they do not have a working regular means of contact (email or phone), or if they are unwilling to share their personal contact information prior to meeting us, then please give them CEF's Durham office phone number (919-797-9233), so that they can call us directly and leave a voicemail. Or, better yet, pick up the phone right now and give us a call while you're together!

Note: CEF's Durham office cannot guarantee that a meeting will be available for walk-ins! We use a meeting appointment system in order to ensure Advocates are available to meet with Members.

CEF's schedule and location are provided on the next page of this form.

About the Person Being Referred
Name of person being referred
Your answer
Phone number(s) of person being referred (if available)
Your answer
Email address of person being referred (if available)
Your answer
Preferred method of contact
Language Preference
What would this person like to work on?
Which goals is this person working on, and what might this person be interested in doing with CEF? Check any and all that apply.
About the Person Completing This Form
Please fill this out if you are referring someone other than yourself!
Name of Person Completing This Form
Your answer
Phone Number of Person Completing This Form
Your answer
Email Address of Person Completing This Form
Your answer
Would you like us to confirm with you once the person has made it to their first meeting?
Is there anything else you would like CEF to know?
Your answer
Referral Source *
Never submit passwords through Google Forms.
This form was created inside of Community Empowerment Fund.