North Star Project Care & Concern Form

North Star Project Care & Concern Form

Thank you for your interest in seeking extra support for yourself/loved one. Please fill out the information below and our Principal Counselor will reach out to you/your loved one within 1-3 business days upon receipt between 9am-5pm. If this is a crisis, please call 988 for the Suicide and Crisis Life Line, text HELLO to 741-741, or call (866) 367-6023 for the Hudson County primary crisis and mental health hotline.
If this is a Crisis - Do NOT fill the form and contact immediate assistance listed above.

Information About Person Completing Care & Concern Form
If you are not a family member: In an effort to provide the most collaborative wrap-around support, a member of our team will contact you prior to initial outreach to family/youth.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship to youth being referred*
N/A if Not Applicable
Is youth aware of this referral? *
N/A if Not Applicable
If you are not a parent/guardian, are they aware of this referral? (N/A if you are parent/guardian)*

Acknowledgement