InReach Program Referral
InReach serves youth located in Spokane County aged 12-24 who are experiencing unaccompanied homelessness by the McKinney-Vento definition, which includes couch surfing, literal homelessness, or any unsafe or unstable living situation. We assist youth in lowering barries to employment, housing, education, and more.
Your Name
*
First Name
Last Name
Your Email
*
We will reach out to you if we cannot get in touch with the referred client.
Your Phone Number
Format: (000) 000-0000.
Referral Source (Agency or relation to the client)
*
Age of the client
*
Their age must be between 12-24
Client's Name
*
First Name
Last Name
Client's Date of Birth
*
-
Month
-
Day
Year
Date
Primary reason for the referral
*
Housing
Employment
Education
Basic Needs
Mainstream Benefits
Regular connection/Support
Mental Health
Other
Phone Number of the client
Please note case managers cannot text participants- only call or email
Format: (000) 000-0000.
Email of the client
example@example.com
Address of the client
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please briefly describe issues client is facing and what they are looking to accomplish by working with our program
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Has the client been involved in any of the following systems of care: Juvenile or adult justice (Jail, probation.), Child Protective Services (DCYF/CPS), Behavioral Health Inpatient Facilities, Drug Rehabilitation Facilities, Mental Health Crisis Centers or Foster Care?
*
Juvenile or Adult Justice (Jail,Probation)
Child Protective Services (DCYF/CPS)
Behavioral Health Inpatient Facility
Drug Rehabiliation Facility
Mental Health Crisis Center
Foster Care
None
Other
Is this referral from Spokane Municipal Court?
*
Yes
No
Please select which program you are referring to?
Youth Adult Shelter (Immediate Shelter, wraparound day services tied to the shelter builidng, and case management services)
InReach (Mobile Case Managment in the community to meet with individuals incarcerated or inpatient, case management services)
Please select the option which most closely aligns with the charge of the client?
Theft, Vandalism, Disorderly Conduct, etc
Sexual Offenses
Violent Offenses (Assault, Murder, Robbery, Arson)
Drug Related Offenses
Other
Does the client have any special needs for shelter?
*
This can include dietary needs, medications, medical needs or any other important aspects of the client's behavior and/or care needs
Submit
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