Client Intake Form

Partner Agency Client Referral Form

Approved partner agency use only (Email info@wewinc.org to get on our partner list).
Welcome!
We're so excited to begin our partnership with you! To ensure we have the information we need to best serve you, please take a few moments to fill out the form below. If you have any questions, please feel free to contact us at info@wewinc.org. Thank you!

Please note our service area is 25 miles from our location 75237.
This form will be maintained; with strict confidentiality and only used by WEW, Inc. Staff to process Career Boutique and furniture requests, make contacts for deliveries and outcome measures, and report demographic/statistical information.
Partnering Agency Name*
Agency Name
Partnering Agency Contact*

First NameLast Name
EMAIL*
example@example.com
PHONE NUMBER*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
REQUEST REGARDING*

Boutique ShoppingHope ProjectSkill ClassesEmpowerment ClassesOther
If you need Boutique shopping (women only), please provide clothing and shoe sizes. For furniture requests through our Hope Project, list the needed items. Please note that we do not supply any appliances. * Resources are Limited*

What is the primary reason that initiated this request for services?
Please upload income Verification (Snap, Medicaid, Pay stub, SSI, etc.) File Upload

Cancelof
Please call (214)238-0073 or email info@wewinc.org to confirm receipt of your request.
Should be Empty:

Partner Agency Client Referral Form