Make a Referral
If you are wanting to submit a referral for either Child-Focused Recruitment or Family Preservation Services, see below for the proper forms.
What Type Of Referral?
Child-Focused Recruitment
CHS in partnership with NCDHHS serves all 100 counties across North Carolina within the Child-Focused Recruitment Program. To refer a youth for Child-Focused Recruitment services, please download and complete the referral form below.
Child-Focused Recruitment Referral Form
Intensive Family Preservation Services
Please download and complete the referral form. Fax the completed form to the local region listed below:
Region #1
Cherokee, Clay, Graham, Haywood, Jackson, Macon, Swain, Transylvania, Eastern Band Cherokee Indians:
Fax: 828-475-6846
Region #2
Avery, Buncombe, Henderson, Madison, McDowell, Mitchell, Polk, Rutherford, Yancey:
Fax: 828-475-6846
Region #3
Alexander, Alleghany, Ashe, Burke, Caldwell, Catawba, Watauga, Wilkes:
Fax: 336-690-5425
Region #4
Cleveland, Lincoln, Mecklenburg, Stanly:
Fax: 336-303-4168
Gaston, Cabarrus, Union:
Fax: 336-790-4944
Region #5
Davidson, Davie, Forsyth, Iredell, Rowan, Rockingham, Stokes, Surry, Yadkin:
Fax: 336-270-2005
Region #6
Alamance, Caswell, Chatham, Guilford, Orange, Person, Randolph:
Fax: 336-270-2006
Region #8
Durham, Edgecombe, Nash, Wilson, Wayne:
Fax: 336-790-4248
Franklin, Granville, Johnston, Vance, Wake, Warren:
Fax: 336-303-4167
Department of Social Services Referral Form

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