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:

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

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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