COP Client Recommendation Form Client Name(required) Client Phone(required) Client Street Address, City, ZIP(required) Client Mailing Address, City, ZIP Client E-Mail Does the client own the home?(required) Yes No Unknown Recommending Agency / Church Recommending Name Recommending Title Recommending Phone Recommending E-Mail Specify the work you believe needs to be done(required) Reasons why this work should be done/What is the client’s situation – could they play a part in work or are there any family nearby? Special client circumstances about which COP should be aware? While it is not required or even requested that the recommended person or family bear any of the cost of materials, some people want to do so in whole or in part. This does not have any bearing on whether COP decides to take on a project! Do you think this might be the case in this situation? Yes No Unknown Any additional information or questions? Submit Δ
