Navigating the Adolescent Years/Open Referral

We accept referrals from community agencies, parents, and self referrals. We follow up on all referrals we receive. Program fees will be assessed by sliding scale based off of income and household size to offset the cost of services.

Are you a parent or a referring organization? *

Youth name *

First Name Last Name

Date of birth *

Date

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

School (if known)

Parent/Guardian Name: *

First Name Last Name

Parent/Guardian Phone Number: *

Area Code Phone Number

What type of phone number did you enter above? *

Parent/Guardian Email Address

example@example.com

Name of Referring Organization

Name of Referring Agency:

First Name Last Name

Organization Contact Name: *

First Name Last Name

Organization Contact Phone Number *

Area Code Phone Number

Organization Email Address

example@example.com

Expected completion date:

Reason for referral: *

Class for Referral:

Navigating Life: Co-ed ages 13-15/16-18 - This program will explore the dangers of using illegal drugs and alcohol. The class also addresses: life consequences and use, abuse and addiction, facts about chemical dependency, the law when using drugs and alcohol, taking risks, consequences of using, and alternative solutions. Seven weeks of 45 minute classes. Power of Conversation: Co-ed ages 13-15/16-18 - Power of Conversation gives students an opportunity to practice communication skills. Students will learn how to better understand their peers, how to identify unhealthy communication that contributes to bullying and anger, how to manage difficult emotions and improve empathy skills. Seven weeks of 45 minute classes. Young at Heart: Co-ed ages 11- 12 - This program is instrumental in building character skills so youth are equipped to make important decisions that they may face when entering society at a young age. Topics include behavior, conflict resolution, personal identification and values within today’s culture. Seven weeks of 45 minute classes. Life Stages Class: Ages 16-18 - Life Stages is an educational program for youth who require more intensive programming. Interactive instruction to students provides detailed information about life consequences and provides motivation enhancement strategies (e.g., health as a value). Class structure incorporates the instruction of active listening, effective communication skills, stress management/coping skills, techniques, self-control, and decision making to counteract risk factors relevant to older teens. Ten weeks of 45 minute classes. A Young Woman’s Journey: Girls ages 13-15/16-18 - Specific to girls, this class curriculum includes healthy decision making skills, leadership development, school cliques, cyber bullying and aggression. The class gives young women opportunities to systematically explore why healthy relationships are critical in their lives. In addition, each girl will learn how to focus on her individual needs, understand how to be safe in the world today, and strengthen her relationships with family, peers, community and society to transform the world she will live in. Ten weeks of 45 minute classes. Parent Navigating: This class addresses Setting boundaries with teens to help reduce the risk for unwanted behavior or actions. Included in this class are components of effective communication that include: providing empathy and validation of feelings, active listening, setting appropriate boundaries, and using “I-Statements.” Six weeks of classes. Pathway to Sobriety: This five month, gender-specific, intensive, substance abuse program offers substance abuse evaluation, instruction of a four step program, and case supervision for youth at the center. This program is based on a 4-Step model and focuses on life skills, enhancement, diet, nutrition, eating disorders, resiliency, group instruction and the development of self-esteem.

Suggested Classes for Referral *

Navigating Life: Co-ed ages 13-15/16-18 - This program will explore the dangers of using illegal drugs and alcohol. The class also addresses: life consequences and use, abuse and addiction, facts about chemical dependency, the law when using drugs and alcohol, taking risks, consequences of using, and alternative solutions. Seven weeks of 45 minute classes. Power of Conversation: Co-ed ages 13-15/16-18 - Power of Conversation gives students an opportunity to practice communication skills. Students will learn how to better understand their peers, how to identify unhealthy communication that contributes to bullying and anger, how to manage difficult emotions and improve empathy skills. Seven weeks of 45 minute classes. Young at Heart: Co-ed ages 11- 12 - This program is instrumental in building character skills so youth are equipped to make important decisions that they may face when entering society at a young age. Topics include behavior, conflict resolution, personal identification and values within today’s culture. Seven weeks of 45 minute classes. Life Stages Class: Ages 16-18 - Life Stages is an educational program for youth who require more intensive programming. Interactive instruction to students provides detailed information about life consequences and provides motivation enhancement strategies (e.g., health as a value). Class structure incorporates the instruction of active listening, effective communication skills, stress management/coping skills, techniques, self-control, and decision making to counteract risk factors relevant to older teens. Ten weeks of 45 minute classes. A Young Woman’s Journey: Girls ages 13-15/16-18 - Specific to girls, this class curriculum includes healthy decision making skills, leadership development, school cliques, cyber bullying and aggression. The class gives young women opportunities to systematically explore why healthy relationships are critical in their lives. In addition, each girl will learn how to focus on her individual needs, understand how to be safe in the world today, and strengthen her relationships with family, peers, community and society to transform the world she will live in. Ten weeks of 45 minute classes. Parent Navigating: This class addresses Setting boundaries with teens to help reduce the risk for unwanted behavior or actions. Included in this class are components of effective communication that include: providing empathy and validation of feelings, active listening, and setting appropriate boundaries. Six weeks of classes. Pathway to Sobriety: This five month, gender-specific, intensive, substance abuse program offers substance abuse evaluation, instruction of a four step program, and case supervision for youth at the center. This program is based on a 4-Step model and focuses on life skills, enhancement, diet, nutrition, eating disorders, resiliency, group instruction and the development of self-esteem.

Please share any additional questions or comments for our staff.