Agency or Department Referral

I am an agency or department and want to refer someone.

Please enable JavaScript in your browser to complete this form.
To refer someone to SCCB for services, please provide the following information.
Referrer Information:
Person being referred:
Please note: There are specific eligibility requirements that a person must meet to receive services. A SCCB counselor will discuss these requirements with the person referred. If you would like to learn more about eligibility requirements, please let us know in the comments.