Next Steps of

South Carolina (NSSC)


Employment and Social Services

Referral Form

The Lazarus Mentor completes this form, giving the original to the Participant to bring to the employment or social services orgnaization to which s/he is being referred, and making a copy of this form and giving it to the Database Management Team Member on duty to transcribe in to the Charity Tracker Plus Database.  The Lazarus Mentor can use the Next Step Program Affiliate telephone number if s/he prefers not to use his/her own phone number.




Agency Name


Address Line 1


Address Line 2


Phone Number


Referral Date



Participant Name


Address Line 1


Address Line 2


Phone Number


Date of Birth


Reason for Referral 






Referred by Lazarus Mentor:


Phone Numbers:



Today’s Date


Additional Lazarus Mentor Notes










Please contact Next Step Program Staff Member regarding questions.

(Check One of the Following Next Step Program Affiliates:)

_______Next Steps of Barnabas Ministries (NSBM)

________Next Steps of Johns Island (NSJI)


Next Steps of South Carolina is indebted to Samaritan Ministry of Greater Washington (, Lazarus Ministry of Christ Episcopal Church, Alexandria, VA (, and The Cooperative Ministry, Columbia, SC ( for allowing us to pattern our Next Step Program after their successful ministries.

(Last modified 4/14/2016)