Youth Referral

apply for the youth empowerment program

Looking for more information on the program? Please visit our Youth Empowerment page.

Please note, while the program is open to all youth between the ages of 12 – 23, due to limited capacity and resources acceptance into the program happens on a first-come, first serve basis. In addition, please note that this is not a generalized “Big Brothers / Big Sisters” style of program; preference will be given to youth who are facing mid-to-high level barriers. For additional resources, we recommend you reach out to your local MFCD (Ministry of Children and Family Development) branch. Youth and their families can also reach out to Foundry.  Foundry offers free and confidential support for young people ages 12 to 24 – mental health care, substance use services, physical & sexual healthcare, youth and family peer supports, and social services – both online and in-person in communities across BC.

This intake is not monitored 24 hours a day.  If you are in crisis, please reach out to emergency services at 911, or the Ministry of Child and Family Development Provincial Screening.  You can also reach out to Kids Help Phone at 1-800-668-6868 or the Mental Health Support Line at 310-6789.


call for assistance

1 (604) 525-1888

Referral Type*

Has the youth consented to this referral? Youth consent is essential to our program.

May we contact the youth directly?*

Urgency for Service*

Youth Commitment Level (how interested is the youth in joining the program)*

Reason for Referral

Is the youth currently taking any substances?*

Is the youth currently taking any medications?

Does the youth currently live at the address listed on the form?*

Has the youth previously received or are they currently receiving any mental health supports, counselling, or treatment?*

Is the youth currently attending school?*

Is the youth eligible for Children and Youth with Support Needs (CYSN)?

How does the youth get themselves around the community?

Does the youth possess a criminal record?*

Would the youth or caregiver like support in filling out further documentation?

Does the youth/caregiver have access to the internet to fill out documentation?

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