The Queen’s Closet Referral Form
Black Excellence Empowerment Inc. (B.E.E.), The Queen’s Closet. Website: www.bee-international.org. Email: President@bee-international.org. Slogan: "Helping Women Dress for the Opportunity They Deserve."
Referral Information
Date of Referral
*
-
Month
-
Day
Year
Date
Referring Organization
*
Referring Staff Member
*
Title / Position
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Client Information
Client Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred Contact Method
*
Phone
Email
Text Message
Client Size Information
Shirt/Blouse Size
*
Pants Size
*
Dress Size
*
Shoe Size
*
Client Consent
Consent Statement
Client Signature
*
Date
*
-
Month
-
Day
Year
Date
B.E.E. Use Only
Date Referral Received
*
-
Month
-
Day
Year
Date
Appointment Date
*
-
Month
-
Day
Year
Date
Services Provided
*
Clothing Provided
Shoes Provided
Accessories Provided
Additional Resources Provided
Staff Initials
*
Submit
Submit
Should be Empty: