3330 Churn Creek Road, Building A-1, Redding CA 96002

Client Referral

Empowering people with diverse abilities to succeed.

Referral Disclosure Agreement
By submitting a client referral through this website, you agree that Rowell Family Empowerment is authorized to use the information presented for the sole purpose of referral to services provided by programs within the agency that will address the needs described regarding the child and the family you refer. 

Every effort will be made to keep the information you provide confidential. This consent pertains only to information collected through this website.

Parent/Family Information

Child Information

English-language learners, or ELLs, are students who are unable to communicate fluently or learn effectively in English, who often come from non-English-speaking homes and backgrounds, and who typically require specialized or modified instruction in both the English language and in their academic courses.

Referrer Information
Name of the place you work for.
Street and number address for the place you work.
Zip code