Please be aware this form must be completed in full. If the form is incomplete it will not allow you to submit the form for referral. If necessary, please list N/A for areas that do not apply to the person you are referring. If you need to contact us with any questions the preferred method of contact is: PF@MARICOPA.GOV
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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