Support for young girls in Halifax

Required fields are marked with an asterisk (*)

Personal Identification of Referred Youth
Name *
Address of Referred Youth:
Referring Individual or Agency
Name *
Address of parent if different from above
Reason for referral
Minimum Requirements *
In addition to meeting the age requirement and living in or near our service areas, the youth must meet two (2) or more of the minimum requirements for a referral to the Youth Advocate Program. Referral does not guarantee acceptance into the program.

Please select applicable box and provide some details about the risk factors that you've identified and are most concerned about by describing incidents or situations involving the youth where the risk factors were in evidence.