Widowed Parent Relief Project: Referral Form
WHO WE ARE
Widowed Parent Relief Project (WPRP) is a volunteer-run, non-profit organization that walks with surviving parents for 12 months to help build an enduring community support system and alleviate everyday stressors, allowing them to focus on their family’s mental health and healing.  We provide paid services related to household management and self care and assist with referring the parent to reliable local businesses or needed services and community supporters.

WHOM WE SERVE
  • Married men or women who have lost their spouse in the last 3 years
  • Living together as a family at the time of spouse’s death or separated for less than 3 months
  • Have children under the age of 18 living with them
  • Living in greater Knoxville area - (Knoxville, Lenoir City, Maryville, and Oak Ridge)  
All referrals are subject to WPRP board approval and our ability to serve is based on the availability of funding and volunteers.  Privacy and sensitivity are of the utmost concern; be assured, responses remain confidential.

You can learn more about us or provide support by visiting www.widowedparentRP.org
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Email *
Are you referring yourself or someone else? *
Required
IF REFERRING SOMEONE ELSE...
Please record the following:
1- Your name
2- Your phone number
2- Your relation to the widowed family 
3- How long you have known them
Surviving Parent's First Name
Surviving Parent's Last Name
Parent's Cell Phone *
Parent's Email *
Parent's Street Name and Number *
Parent's City *
Parent's State *
Parent's Zip Code *
Marital status of the widowed parent? *
If you answered "Other" above, please describe the living situation at the time of spouse's death.
 Deceased Spouse's Full Name *
Spouse's date of death *
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/
DD
/
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We only serve widow(er)s who have children under the age of 18 living in the home. How many children under the age of 18 live in the home? *
At this time, who assists/supports and in what ways? (Family members, friends, church, neighbors, other organizations, etc.) *
As a volunteer-based organization, WPRP walks with the surviving parent for 12 months, assisting him/her in building an enduring support network and providing paid services related to household management and self care.  There are sometimes situations where more complex needs require professional support, and we do our best to connect the family with those providers.  Please check the box if any of the following statements are true: *
Required
Please share any additional circumstances that might help advocate for partnership to our WPRP Board.
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