An Angel's Wing Thrift Store

Community Referral Application

Helping individuals and families access essential items with dignity.

This referral form is available to community organizations, case managers, treatment and recovery providers, schools, healthcare providers, shelters, social service agencies, and other community partners seeking essential items for an individual or family they serve.

Please submit one referral per individual or household.

Requests are based on current donated inventory. Submission of a referral does not guarantee that every requested item will be available.

Fields marked with * are required.

Referring Organization

Organization/Agency Name*

Referring Staff Member Name*

Title/Position

Email Address*

Phone Number*

Organization Address

Preferred Method of Contact

EmailPhone

Individual or Family Being Referred

Name of Individual/Head of Household*

Phone Number

Email Address

Number of Adults in Household*

Number of Children in Household*

Preferred method for coordinating pickup

Contact the referring organizationContact the individual/family directlyEither is acceptable

Highest Priority Needs

If we cannot fulfill the entire request, please identify the three highest-priority items. This helps our staff address the individual's or family's most immediate needs when inventory is limited.

Priority #1*

Priority #2

Priority #3

Timeframe

When are the items needed?*

If this is an urgent request, please briefly explain.

Additional Information

Is there anything else our team should know to help fulfill this request?

Please do not submit unnecessary medical, treatment, financial, or other confidential information.

Referral Verification

By submitting this referral, I confirm that:

I am submitting this request on behalf of the organization identified above.
To the best of my knowledge, the individual or household currently needs the items requested.
I understand that An Angel's Wing relies primarily on donated merchandise and cannot guarantee availability of specific items, brands, sizes, quantities, or furniture.
I understand that submitting this referral does not mean the request has been approved or that items are ready for pickup.
I understand that the individual/family should wait for confirmation before arriving to receive requested items.

Referring Staff Member Name*

Date*

* I have read and agree to the statements above.

Fields marked with * are required.

Back to Get Involved

Community Referral Application

Referring Organization

Individual or Family Being Referred

Current Need

Items Requested

Clothing

Baby & Children's Items

Household Items

Furniture

Personal Care & Other Essential Items

Highest Priority Needs

Timeframe

Additional Information

Referral Verification