Referring Organization contact information
Child/youth contact & general information
While children in permanent care will be prioritized, children in care temporarily, children in customary
care, youth living independently and youth living in kinship care are also eligible for the program.
child/youth education information
Please provide a brief description of how the child/youth is doing in school
(i.e. are they performing at grade level, are they struggling with any particular subjects, are they
currently accessing any education-based resources such as tutoring, are they engaged in the school or
Reason for referral
Please provide a brief description of the child/youth’s situation and reason for referral (i.e. why do you
think they would be a good fit for/benefit from the program?).
Contact for intake