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.

To apply for the program, please fill out the online application form below.

call for assistance

1 (604) 525-1888

call for assistance

1 (604) 525-1888

Referral Type*

May we contact the youth directly?*

Urgency for Service*

Is the youth currently taking any substances?*

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

Is the youth currently taking any medications? If so, please list them below*

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

Has the youth previously received any counselling or treatment?*

Is the youth currently attending school?*

Does the youth possess a criminal record?*

5 + 12 =

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