Snohomish County Referral Form

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In Snohomish County, LCYC provides free civil legal services to young people between ages 12-17 who are experiencing, or at risk of, housing instability. Housing instability includes, but is not limited to: homelessness, couch surfing, struggling to access emergency shelter, temporarily living with friends or family, facing eviction, or feeling unsafe/unwelcome at home.

To request legal services from LCYC's Youth Homelessness Program in Snohomish County, complete this referral form. Referrals must come from Cocoon House.
Today's date*

MonthDayYear
Who needs legal services?*

I am a youth making a referral for myselfI am making a referral for a youth

Youth's Contact Information
If the youth needs an interpreter, enter which language below.
What are the best ways to contact the youth?*

Phone callWhatsAppEmailSnapchatTextOther
Youth's phone number
Youth's email address
Youth's address, if available
What are the best times to contact the youth?

Contact Information
If you need an interpreter, enter which language below.
What are the best ways to contact you?*

Phone callEmailTextSnapchatWhatsAppOther
Your phone number
Your email address
Your address, if available
What are the best times to contact you?
Should be Empty:

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