Perfect Fit Referral

HomePerfect Fit Referral

General Referral For The Perfect Fit

The Perfect Fit’s mission is to empower women with the confidence they need to accomplish their goals.

Please complete this form for us to schedule an appointment for your client or yourself if this is a “self” referral.

IMPORTANT: This form is NOT for clients receiving TANF benefits. All clients currently receiving cash assistance from the State of Pennsylvania MUST be referred by their county caseworker using the PAWW (PA Work Wear) Referral.

Upon submission of the completed form, we will contact the client by phone to schedule an appointment.

We are located at 609 W. Hamilton St. Suite LL200 in Allentown, PA. Any questions please call our office at 610-871-5060 or email us at info@ywcaallentown.org.

Please do not bring children or other guests with you to your appointment. We encourage you to use your time at the Perfect Fit to focus completely on YOU– your goals, your plans, your choices.

Perfect Fit General Referral

Referral form for the Perfect Fit for Working Women

Date(Required)

MM slash DD slash YYYY

Type of Referral (Please check one option)(Required)

Agency Referral

Self Referral

Client's Legal Name(Required)

First Last

Client's Preferred Name

Preferred Name

Reason for Referral(Required)

Interview/Employment Search

New or Existing Employment

Uniform Clothing (Example Scrubs)

Training/School/Internship

Client's Phone Number(Required)

Client's Email Address

Is this the client's first visit to the Perfect Fit?

Yes

No

Unsure

Your Name(Required)

First Last

Your Email(Required)

Enter Email Confirm Email

Name of Referring Agency (if applicable)

How did you hear about us?(Required)

YWCA Website

Social Media

Friend

Co-worker

Referring Agency

2-1-1

Other

Is there anything else you would like us to know?

609 West Hamilton Street, Suite LL200, Allentown, PA 18101 | Phone: (610) 871-5060 | Fax: (610) 871-5061 | EIN 23-1352605 | info@ywcaallentown.org

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