Referral Form for Gift Cards

The purpose of this form is to request gift cards. This gives $50-$200 per household, depending on the number of people. They will usually be for Fred Meyer, and at times, to Target or Winco instead.

Refugee Care Collective partners with local resettlement agencies: Catholic Charities of Oregon, Ecumenical Ministries of Oregon, IRCO, and Lutheran Community Services Northwest. This program is for R&P clients only.

Our team will be in touch with you, confirming the gift cards and pickup information.

Thank you for your work!

Gift cards must be given to the client, and not used to purchase items on their behalf. Upon filling out this request form, you agree to give the gift cards directly to the client.

Gift cards are distributed once to each household with potential for further distribution as there is a pressing need, not to exceed 1-2 times per year.

"*" indicates required fields

Date Submitted

Client's Full Name:*

If this request is for the whole family, please include the full name of the head of the family here + "Family." (Ex. Hussain Muhammad and Family.) If this is for an individual client, please only include the client's name.

Client's Country of Origin:*

Date of Arrival:*

Client's Address:*

Client's Phone-Number:*

Resettlement Agency that Resettled Client in Oregon:*

(Catholic Charities of Oregon, Ecumenical Ministries of Oregon, IRCO, Lutheran Communities Services Northwest)

Number of People in Family:*

Genders and Ages in Family:*

(Ex: 37 year old mom, 9 year old girl, 7 year old boy)

Name of Person Referring:*

Email Address of Person Referring:*

Referring Organization:

Please state the referring organization if different than the resettlement agency listed above.

Referral Form for Gift Cards

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