HOPE Buffalo is a community-led movement in the City of Buffalo focused on supporting adolescent health and well-being. Through HOPE Buffalo, partners connect young people to trusted resources and caring adults that support healthy decision-making.

Information collected through this form helps HOPE Buffalo understand referral patterns, strengthen connections across community resources, and ensure young people are able to access the services they need.

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Name: (Required.)

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Organization/Affiliation:

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Role/Position:

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Date of referral (Required.)

Date

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Please share the types of referrals you connect youth to. You can include multiple referrals and list more than one organization or service within each section. (Required.)

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Age range of young person referred (Required.)

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How was the referral made?

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To your knowledge, was the young person able to access the service?

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Additional notes:

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