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:

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* Organization/Affiliation:

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* Role/Position:

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* Date of referral

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.

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* Age range of young person referred

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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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