For case managers & partner organizations

Submit a partner referral.

Use this form when your organization is actively serving an individual or household and wants Be Kind Birmingham to consider a coordinated assistance request.

Referral standard: Please confirm that your organization has permission to share the information below and will remain available for coordination. Assistance depends on inventory, program fit, geography, restrictions, and capacity.

Referring organization

Organization name

Referring staff member

Work email

Work phone

Person being referred

Full name

Phone number

Email address

City or ZIP code

Household size

Preferred contact method

Assistance requested

Primary need

Transportation or accessibility needs

Tell us what is needed

Referral coordination

How is your organization currently working with this person or household?

Relevant timing or deadline

I confirm that the person being referred agreed to this referral and that Be Kind Birmingham may contact the people listed. I understand that submitting a request does not guarantee assistance.

Do not include Social Security numbers, financial account information, medical records or detailed trauma histories. This form is not monitored for emergencies.

This secure action opens your email app and addresses the message to bekindbhm@gmail.com with the correct subject. You must press Send in your email app.