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.

Our Flyer

Our Brochure

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:

Alexander, Alleghany, Ashe, Burke Caldwell, Catawba, Watauga, Wilkes
Fax: 336-690-5425

Cleveland, Lincoln, Mecklenburg, Stanly
Fax: 336-303-4168

Union, Cabarrus, Gaston
Fax: 336-790-4944

Durham, Edgecombe, Nash, Wilson, Wayne
Fax: 336-790-4248

Franklin, Granville, Johnston, Vance, Wake, and Warren
Fax: 336-303-4167

Our Flyer

Our Brochure

Department of Social Services Referral Form

Department of Juvenile Justice Referral Form

Child Mental Health Referral Form

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