What’s Next: Resource Recommendation

About You (Kept Private)

First Name(Required)

Last Name(Required)

Phone Cell

Your privacy matters: Your name and contact information will be kept strictly confidential and used only by the What’s Next Committee to follow up if needed. This information will not be shared with anyone else.

About the Organization

Organization(Required)

Please enter the full name of the organization, business, or service you’re recommending.

Type of Resource(Required)

Select all that apply

Other (please specify)

Organization Website and/or Contact Info

Please include the organization’s website if available. If there’s no website or it doesn’t list contact details, feel free to provide a contact name, phone number, email address, or other way to reach them.

Brief Description

What do they do? What makes them helpful?

Your Experience

How do you know about this organization?(Required)

I have used this organization myself

A friend, neighbor, or family member recommended them

I’ve heard good things from others in the community

Other

Other (please specify)

Additional Comments

Use this space to share anything else you think we should know about the organization or your recommendation.

Permission to Share

Permission to Share(Required)

Yes, I give permission to share this organization

No, please keep this information confidential

Permission to Share — What It Means
We value your trust and want you to feel comfortable sharing your recommendations.
When you give permission to share, the organization’s information will be added to our public Hearts of Miromar community resource list, helping other members find trusted services.

If you choose not to give permission, your recommendation will still be reviewed confidentially by the What’s Next Committee but will not be shared publicly. (For example, the organization may prefer limited exposure or only serve a small number of clients at a time.)
Thank you for helping us build a trusted network of resources while respecting everyone’s privacy.

Ready to Submit?

What do the buttons below mean?

Submit – Click this when you’re all done and ready to send your form to the What’s Next Committee. Once you submit, you won’t be able to go back and make changes.

Save & Continue – Not finished yet? That’s okay! Click this to save your progress. You’ll be asked to enter your email, and we’ll send you a special link so you can come back and finish the form later—any time that works for you.