Make a Referral

Do you know a child in need of residential services? Please fill out the information below, download and print the application form, and mail or bring the completed referral application to either of our facilities:

Blessed Alms, Inc.                               Blessed New Beginnings, LLC
4321 Rehobeth Church Rd.               515 Guilford College Rd.
Greensboro, NC 27406                      Greensboro, NC 27409
Phone: (336) 379-1314                       Phone: (336) 315-6060

Note: All signatures must be made in-person at the actual admission to our facility.

* denotes a required field


Your name*

Your email*

Your phone number (format: 555-555-5555)

Name of your agency

Name of the child you are referring*

Age of the child you are referring*

Gender of the child you are referring*

How did you hear about us?

Comments (1,000 characters maximum)

Please click here to download the printable referral application form