Helping youth at risk

Youth Advocate Program

Required fields are marked with an asterisk (*)

Personal Identification of Referred Youth
Gender *
Referring Individual or Agency
Referring email
Reason for Referral
Minimum Requirements*
In addition to meeting the age requirements and living in or near our service areas, the youth must meet two (2) or more of the minimum requirements while having some level of police involvement 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.
In accordance with Section 485 of the Municipal Government Act (MGA), the personal information collected on this form will only be used by Halifax Regional Municipality staff for purposes relating to the administration of this application." If you have any questions about the collection and use of this information, please contact Halifax Regional Municipality Access and Privacy Office at 4902.490.7460 or
Enter the characters shown in the image.