Referral Form

Complete the online referral form below to refer a child to YSB.

OUR MISSION IS TO HELP YOUTH AND FAMILIES LEARN THE SKILLS THEY NEED TO BE MORE SUCCESSFUL… AT HOME, IN SCHOOL, AND THROUGHOUT THE COMMUNITY.

TroubledTeen

Concerns that YSB can help a family with can include: academic problems, emotional health, alcohol and other drug use, bullying, curfew violation, disorderly conduct, electronics, runaway, theft, trespassing, truancy, vandalism and more.

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Youth's Gender(Required)
Youth's Name(Required)
Parents/Guardians(Required)
Address(Required)

Referral Source Information

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Max. file size: 122 MB.

YBS Programs Requiring Completion

Bullying Awareness Program (BAP)
Chemical Awareness Program (CAP)
Community Work Service (CWS)
Counseling Services
Distracted Driving Awareness Program (DDAP)
General Assessment (GA)
Responsible Social Media Use (RSMU)
Theft Awareness Program (TAP)
Teen Intervene (TI)
Victim-Offender Services

Referring Party Confirmation

Referring Party Agreement # 1(Required)
Referring Party Agreement # 2(Required)

Youth/Family Responsibility

Client/Family Responsibility It is the responsibility of the family to contact a YSB office within 3 days to initiate the programs selected above: