Widowed Parent Relief Project: Referral Form
WHO WE ARE
Widowed Parent Relief Project (WPRP) is a volunteer-run, non-profit organization that walks with surviving parents for 12 months to help build an enduring community support system and alleviate everyday stressors, allowing them to focus on their family’s mental health and healing.  We provide paid services related to household management and self care and assist with referring the parent to reliable local businesses or needed services and community supporters.

WHOM WE SERVE
  • Married men or women who have lost their spouse in the last 3 years
  • Living together as a family at the time of spouse’s death or separated for less than 3 months
  • Have children under the age of 18 living with them
  • Living in greater Knoxville area - referrals for parents from other areas will be kept for future consideration
All referrals are subject to WPRP board approval and our ability to serve is based on the availability of funding and volunteers.  Privacy and sensitivity are of the utmost concern; be assured, responses remain confidential.

*** If you are a widow(er) yourself, please click this link to complete a Self-Referral Form instead of this one: https://docs.google.com/forms/d/1QYfM21aMHB2pPUjbTE9BWoiqAP96g3XY_eJCnpxxy5U/edit

You can learn more about us or provide support by visiting www.widowedparentRP.org
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Email *
We serve married men or women who have lost their spouse in the last 3 years and were living together as a family at the time of spouse’s death (or separated for less than 3 months). What was the marital status of the Referred Parent? *
If you answered "Other" above, please describe the family's living situation at the time of spouse's death.
Number of children under the age of 18 living in the home
We serve those who have been widowed in the past 3 years. What is the death date of the deceased spouse?
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 Deceased Spouse's Full Name *
Surviving Parent's First Name
Surviving Parent's Last Name
Parent's Cell Phone
Parent's Email
Parent's Street Address
Parent's City, State, and Zip Code
At this time, who assists or supports the widowed family and in what ways? (Family members, friends, church, neighbors, other organizations, etc.)
As a volunteer-based organization, WPRP walks with the surviving parent for 12 months, assisting them in building an enduring support network and providing paid services related to household management and self care.  There are sometimes situations where more complex needs require professional support, and we do our best to connect the family with those providers.  Please check the box if any of the following statements are true: *
Required
Please share any additional circumstances that might help advocate for the family with the WPRP Board.
Your (Referrer's) Full Name
Your Cell Phone Number
What is your relation to the widowed family and how long you have know them?
From whom or where did you learn about WPRP?
A copy of your responses will be emailed to the address you provided.
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