YouthLink Referral

YouthLink Referral
The purpose of YouthLink is to foster goal-based strategies for developing strong families and healthy communities through multi-system collaboration.

YouthLink can provide:

🔹 Screenings & Assessments

Identifies risks, strengths, and protective factors.

🔹 Coaching & Service Planning
- One-on-one support to build skills and achieve goals.
- Referrals and coordination for professsional services.
- Educational programs/mentoring.
🔹 Flexible Funding

Can remove barriers to participation and fuel success with goals:
- Pay activity or program fees
- Cover equipment for sports, art, band, etc.
- Incentives for goal achievement
- Rewards for positive behavior
Youth Info
Name of Youth*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Language

English OnlySpanish OnlyBilingualOther
Gender

MaleFemaleIf other - please specify here
Race/Ethnicity

Black/African AmericanHispanicNative AmericanMixed RaceAsian/Pacific IslanderWhiteIf other, please specify here
Parent Info
Parent/Guardian

First NameLast Name
Parent Phone Number
Parent Language

English OnlySpanish OnlyBilingualOther
Details
School
Grade Level?
Concerns that are prompting this referral: (select all that apply)

Anger/FightingAnxiety/DepressionBehavior at homeBehavior at schoolBullying - aggressorBullying - victimCriminal Behavior (theft, curfew violations, vandalism, etc.)Failing GradesFamily ConflictGang InvolvementLack of MotivationLonely/IsolatedMinor in PossessionNegative Peer InfluencesRecent change in lifestyle (move, divorce, etc.)Recent TraumaSelf-Harm/Suicidal ThoughtsSextingSubstance UseTruancyOther
Does this youth currently have pending court charges?

YESNOUNSURE
If yes, please specify which court

Sterling Municipal CourtDistrict/County CourtOther
Description of Incident Prompting this Referral (if applicable)
Referral Source
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number
Your Agency
Your role with this youth

Law EnforcementSchool Resource OfficerSchool StaffChild Welfare StaffCommunity AgencyParentOther
Additional Details
YouthLink Service Requests (OPTIONAL) select all that apply:

To Be DeterminedRisk Screening/Needs AssessmentAdvocacyCoachingEducational ProgramFlexible Funding for Goals (TEAM Up for Success)MentoringService Planning (for therapy, substance treatment, etc.)TEAM Meeting
Comments:
Should be Empty:

YouthLink Referral

Youth Info

Parent Info

Details

Referral Source

Additional Details