Referral forms must be completed by a guidance counselor, teacher, church leader, or social service representative. If you are Family member that would like to refer a girl please contact Amy or Nikki, from the contact page, for further instructions.

In order for students to recieve an invatation to the botique, forms must be recieved back no later than April 1, 2009

If you prefer to fax or mail your referral the form is downloadable at the bottom of this page.


This area to be filled out by the referee

First name : Last name :

Position/Title :

Organization :

Address :

Phone Number : Fax :

Email :


I am Referring:

First name : Last name :

School :

School Address :

Home Address :

Phone Number :

Email :

Special Needs :

Junior Senior        Dress Size

Reason for referral :

How would this student benefit from the botique :

                                      



You may also download the form by Clicking here.