Youth Referral Form

Thank you taking the time to fill out the Bright Futures for Youth (BFFY) referral form.
If you’re not sure which program(s) would be best suited for the youth or if you have questions about the referral process, please contact Dena at (530) 265-4311 or denam@bffyouth.org.



(if other, provide your relation to youth)
BFFY Youth Programs

The Friendship Club is a long-term program that provides year-round academic, social and emotional support for youth who are female, female identifying, or gender non-conforming in 6th grade through high school.
NEO offers a fun, safe and supervised space for youths, grade 6th to 12th, to spend their time after school and during the summer. Special activities, events and workshops are offered throughout the year for youth and also for ages 18-25.
SAFE helps youth ages 12 to 26 in need of social services and case management, including youth who are experiencing homelessness or housing instability. SAFE provides basic needs support and ensures access to community services.
Referrer Contact (person referring the "youth")








Parent/Guardian Contact (LG1)




(landline only; in case of emergency)



Youth Information (person being referred is "youth")







(provide specifics of youth gender)


(provide specifics of youth pronoun)


(provide specifics of youth orientation)



(Enter your social media or other number/email that we may use to contact you)

(best way for program staff to contact youth)




(Select grade; entering in fall semester)












(if other, provide details of youth's ethnicity)
Youth Program Referred
The Friendship Club Referral






(provide information for all checked above)








(check all that apply)

(provide details if known)


NEO Referral




SAFE Referral
Household & Dependents

Dependent Information
To add additional dependents, click on "Add another response"




(do NOT include dependents listed above)
Household Member Information
To add additional household members, click on "Add another response"



Education




Housing, Safety & Legalities








(check all that apply)

(provide a brief description)

(provide a brief description)

(provide a brief description)


(provide additional information)
Services & Summary

(check all that apply)


(check all that apply)



Contact Information