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SWYFS External Referral Form

Welcome to Southwest Youth and Family Services! We partner with youth and families to transform futures, through education, youth development, behavioral health, and family advocacy.

Please take a few minutes to fill out this referral form for the person you think would benefit from partnering with us.

The information you provide on this form is private and confidential and will be sent directly to the department you indicate you are referring to.

Which program would you like to refer to?*
I am

STOP!! 

If you are a SWYFS employee making a referral for a current SWYFS client, please fill out the SWYFS Internal Referral Form instead. Thanks!

Note: SWYFS' Behavioral Health services include two levels of support: case management (support in connecting to resources) and clinical mental health counseling.

If you feel the person you are referring would benefit more from mental health counseling services, please fill out the counseling referral form.

Participant's Name*
Participant's Date of Birth*
Participant's Gender*

Case Management Referral Information

SWYFS Case Management

Case Management provides holistic and comprehensive services that provide multiple sources of support to meet the individualized needs of young people ages 14-24 harmed by the criminal legal system.  Systems navigation includes individualized case management, family advocates to navigate systems, culturally responsive educational support, and flexible funding to meet basic needs.  Trauma intervention activities include behavioral health supports for individuals, families, and groups; Peacemaking Circles; and Aggression Replacement Training (ART).

Youth Information

Youth's Address*
Youth's preferred method of contact (if known)
Service(s) youth might need (Please check all that apply)*
Is the youth involved in any activities? (Please check all that apply)*
Is participant currently receiving other services, including case management, from another organization?*
Does youth know you are making this referral?*
Are they willing to participate?*

Referral Source Information

Name of person making referral*
Please check off the referral source:*
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