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Community Member Referral Form

CII’s LAUNCH program is focused on building relationships between current and former system-involved youth (14 -27), mentors and peers. This program is intended to support your educational success, identify meaningful career opportunities, support your emotional and physical wellness and help you develop a network of support for navigating life’s journey. Fill out the form below to refer a youth into this program and a CII staff member will follow up. Thank you for your partnership!
1.Contact Information of the Referrer(Required.)
2.Referred Youth Information(Required.)
3.Are you a current or former foster youth?(Required.)
4.Are you a current or former probation youth?(Required.)
5.Is it okay for a CII staff member to contact the youth directly?
6.Please feel free to provide any additional information/context you'd like us to know.
Thank you for your time in filling out this survey.