Will you help find the best candidates for Pivot?


If so, please identify your top recommendation(s) of low-income, working-age women who are:

  • ready to make a change in life
  • without minor dependents in the home
  • willing to commit and to participate in weekly classes
  • interested in building community with others
  • open to a Biblical foundation and a one-on-one Christian mentor.

Please answer the following questions as you understand each referral’s current situation while honoring your confidentiality agreement.  Required fields are marked with an asterisk (*).

Please be sure to hit SEND (at the bottom of the form) when it’s complete.

    1. Referral Source

    Your Name *

    Your Phone *

    Your Email *

    Your Organization *

    2. Woman You Are Referring

    Name *

    Address *



    Accepts Texts?

    Authorized This Referral? *

    Approximate Age *

    3. Why Refer

    Why is she right for Pivot? *

    Why is Pivot right for her? *

    Please describe opportunities or roadblocks she faces that your organization doesn’t address:

    Please describe any life change or specific event that makes her ready to make a change: *

    4. Your observations

    Her motivation:

    Her goals or vision for herself:

    On a scale of 1 to 10 with 10 being absolute highest, rate this woman's readiness to commit to change in her life: *

    Interest level in Pivot: *
    LowMediumHighVery HighUnknown

    5. Her situation

    Approximate Annual Income: *

    Currently Employed? *
    NoYes - Part TimeYes - Full time
    If 'yes', describe:

    Other sources of Income:

    Availability for classes/events (check all that apply as you understand her typical schedule)
       Mid-morning/mid-afternoon MTuWThFSa
       Late-afternoon/evenings MTuWThF

    Transportation methods (check all that apply)
    Independent DriverSpouse/significant otherFamily MemberFriendsPublic TransportationOther:

    Would an occasional male instructor be an impediment for her?

    Describe or list known obstacles or impediments to her success:

    Other programs in which she is participating or has done so in the past:

    General summary/history that you can share:

    6. Other Comments