Youth Referral Form for MYDC
Use this form to refer a young person for support at Metro Youth Diversion Center. Have all relevant information ready.
Metro Youth Diversion Center (MYDC) provides culturally responsive diversion, mentorship, prevention, health navigation, crisis support, and community resources for youth and families. We are committed to trauma-informed, inclusive, and supportive care. Please note: This is not an emergency service. For emergencies, call 911 or your local crisis services. For questions, contact us at 612-423-3919.
Your Full Name
*
First Name
Last Name
Your Organization or Relationship to Youth
*
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email Address
*
example@example.com
Preferred Contact Method
*
Phone
Email
Text Message
Other
Youth's Full Name
*
First Name
Last Name
Youth's Age
*
Youth's School (if applicable)
Parent or Guardian Name
First Name
Last Name
Parent or Guardian Phone or Email
Reason for Referral
*
Type of Support Needed
*
Diversion Support
Mentorship
School Support
Crisis or Family Support
Health or Resource Navigation
Violence Interruption or Safety Support
Career Readiness
Other
Urgency Level
*
Low (routine support)
Medium (needs attention soon)
High (immediate follow-up needed, but not an emergency)
Brief Description of Situation
*
Safety Concerns (if any)
Best Time to Contact
Submit Referral
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