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Referral Form
Thank you for submitting the referral. CARE will contact the individual within 24-48 hours. If you need further assistance, please email CARE at care@utep.edu
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Today's Date:
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Referred Person Name:
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UTEP ID Number:
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Phone Number:
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UTEP Email Address
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Brief description or reason for referral:
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Referring Party Name:
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Department
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