CC INC Referral

Cumberland County CCINC form
It is the intent of the Cumberland County Identify.Notify.Care (CC INC) to identify, through the deployment of these criteria, those youth most at-risk for involvement with gangs and gang violence. CC INC strives to prevent and reduce gang membership and violence of youth in Vineland, Bridgeton and Millville.

Ultimately, CC INC seeks to have a long-term, positive and life enhancing change on the referred youth.
These goals are pursued through collaboration among criminal justice and law enforcement agencies, Credible Messengers, community organizations, faith-based organizations, and social service providers.

In order to be invited to join CC INC, a youth must meet the first 3 criteria listed AND preferably 2 of the remaining criteria below. If the youth does not meet the Influences on Youth Eligibility Factor,
they must meet 3 of the remaining criteria below.
Please select which essential criteria this youth meets

Age: Youth is under age 18Residency: Youth resides in Vineland, Millville, BridgetonInfluencers on Youth" Youth who have a familial or close tie with current gang member(s) and gang violence. Example: youth is the younger cousin/brother/sister/son/daughter/grandchild/niece or nephew of a gang member currently perpetuating gang violence in Vineland, Millville, or Bridgeton
Please select which additional criteria this youth meets

Youth criminal history and discretion: Youth who are demonstrating serious risky behavior, including but not limited to, gang involvement, gang-related violence, distribution of CDS, as well as fraternizing with gang associates or other delinquent peers. Youth exposure and use/abuse of alcohol and/or drugs should also be a circumstance for referral to CCINC.Performance and Behavior in School: youth who are, including bu not limited to, chronically absent from school (5 or more unexcused absences; late for school 5 or more times; have been expelled or suspended; performing below grade level academically; receiving poor grades; exhibiting defiant behavior at school/ receiving referrals for detentions or disciplinary action; engaging in bullying. Youth who have dropped out of high school or have not attended in a while are also highly recommended for CCINC.Family's History with Law Enforcement: Youth who come from families who are, including but not limited to, known to law enforcement, have family members involved (past or present) with the criminal justice system; or a parent incarcerated within the last two years.Home Situation: Youth who come from, uncluding but not limited to, an undtable home life as guaged by being raised by someone other than a parent; domestic abuse in the family; having lack of adult supervision in the home; residing in a known gang area; history of loss (death or abandonment); or is known by DCP&P (past or current case).Other: This can include victimization and exposure to trauma, specifically community violence

Referral Information
Referral Information
Referral Agency/Individual
Contact Person
Contact Phone
Contact Email
example@example.com
Referral Person (if different than Contact Person)
Referral Person Phone
Referral Person Email
example@example.com
Primary Reason for Referral

Youth & Family Information
Youth and Family Information
Youth Date of Birth

MonthDayYear
Date
Age
Gender
Race & Ethnicity
Who does the youth live with?

MotherFatherGrandparentsAunt/UncleFoster ParentOther
Number of siblings
Youth Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family Contact Person
Family Contact Phone
Family Contact Email
example@example.com
Primary language spoken at home

EnglishSpanishOther
Important Health Info
Any Faith or Religious Affiliation Info to Share
Name of School
Grade
School Contact
Phone
Title
Email
example@example.com

Cumberland County CCINC form

Referral Information

Youth and Family Information

Eligibility Details