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Working together to support Black Women!

This referral form allows us to connect individuals and families to supportive, healing-centered spaces through Queens Village.

We believe care travels best through trusted relationships. If you know someone who could benefit from connection, encouragement, or community-based support, you can use this form to refer them.

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Our goal is simple- to meet Black women with dignity, compassion, and care. 

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Role/Relationship to participant
Provider
Community Partner
Family/Friend
Self
Other
Preferred Contact Method
Call
Text
Email
Pregnancy/Parenting Status
Reason for Referrals (check all that apply):
Identified Needs (check all that apply)

Copyright 2025 by Project Ujima(TM), a 5013C non-profit based in Akron, OH.

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