If you need to refer someone to our mentoring program, please fill out the following form.
Youth's First Name
Youth's Last Name
Name of School
Relationship to youth (Mother, Father, Other: Please specify)
Name of Referent
Your Phone Number
Why do you think this youth would benefit from the SCCYI Mentoring Program?
Describe the youth (personality, strengths, etc.)
Useful strategies for working with this youth:
Medical concerns that the Mentoring Program should be aware of (allergies, medications, etc.)