Y-NOW Mentoring Program Referral Form Logo

  • YMCA Safe Place Services – Y-NOW Mentoring Program Referral Form

  • Y-NOW is a free, 10-month mentoring program for Louisville youth ages 11–15 who have a parent who is or has been incarcerated, or who is battling addiction.

    These youth often face stigma, isolation, and emotional challenges that can impact school, relationships, and well-being. Y-NOW connects them with caring, trained mentors who offer support, encouragement, and a safe space to grow.

    The program begins with a 3-day retreat, followed by 10 months of weekly one-on-one mentoring, biweekly group sessions, and 4 family-centered events. Transportation is provided.

    Please complete this form to refer a youth. You’ll be asked to share:

    • Information about the youth
    • Caregiver contact details
    • Your contact information as the referrer

    If you have questions, the Y-NOW team is here to help.

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  • Youth Information

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  • Note: This youth does not meet the age eligibility for the Y-NOW Mentoring Program (ages 11–15).

    However, we still invite you to complete the referral form. YMCA Safe Place Services may have other resources or programs that could support the youth or family. Shelter House is available to youth ages 12-17 and the Youth Development Drop-In Center is open to teens and young adults ages 18-24. Our team will review the information and follow up as appropriate.

    If you have questions or have a teen in need of immediate assistance, call or text 502-635-5233.

  • If submitting during the school year, please enter the youth’s current school and grade. If submitting during summer, please enter the school and grade they will be entering in the fall.

  • While it’s not required that you speak with the youth before submitting a referral, doing so greatly increases the chances that they’ll be open to learning about and participating in Y-NOW.

    If you’d like help starting this conversation, our team is happy to support you.

  • Caregiver Information

  • While it’s not required that you speak with the caregiver before submitting a referral, doing so can help build trust and improve the youth’s experience in the Y-NOW program.

    If you’d like help starting this conversation, the Y-NOW team is here to support you.

  • Referral Submitted By

  • Please tell us a bit about yourself so we can follow up if needed. This information helps us stay connected and ensure the youth receives appropriate support.

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