Refer A Mom

Know a young mom or expecting mom who could benefit from Shine’s programs? Fill out the form below and we’ll be in touch within one business day.

Prospective Participant Information

*Required Field

First*

Last*

Home Phone

Cell Phone*

Is the prospective participant pregnant or parenting?*

If pregnant, what is the due date for the baby?

Has the prospective participant graduated high school?*YesNoUnsure

Is the prospective participant enrolled in school?*

Name of the prospective member’s current school (if applicable):

Preferred language?*

Please let us know what language to prospective member prefers to communicate in. We have Spanish-speaking advocates and bilingual learning groups.

Shine currently has programs in the following cities:
Fresno, CA, Greenfield, CA, Sacramento, CA, Salinas, CA and San Jose, CA

Please select the city closest to you. *Fresno, CAGreenfield, CASacramento, CASalinas, CASan Jose, CAOther

If you selected Other, please specify in which city and state you live in.

Do they have a Case Manager/Social Worker/Home Visitor (from any program)?

If you selected yes for the above question, please choose which other service(s) support the prospective participant? (mark all that apply): Nurse Family Partnership (NFP)Adolescent Family Life Program (AFLP)Probation ServicesTeen Parent Support Program (TPSP)Cal-LearnFoster Care ServicesUnknownOther