Children and Family Community Supports Referral 


How can we help you, your children, family members or a friend in need? 

Our goal is to decrease barriers that may impact children's attendance and success at school.

We can help you with:

Childcare Referrals

Medical & Dental Referrals

School Supplies

Transportation Problem Solving

Mental Health Counseling Referrals

Connecting the family Community Resources

(Housing support referrals, food, clothing etc.)

Guidance and Mentoring for DeKalb County Youth

Ensuring the child will have access to educational opportunities 

Support with School Registration Process

Youth Mentoring (Ages 12-18)

Supports for young Children (Ages 0-5)


By submitting this form you are consenting to having your families information placed into our confidential integrated referral and intake system (IRIS). Please add any details you feel would help our team to properly assist your family or friends. Thank you for your time and someone will be contacting you to follow up.
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Person Completing this form and their Relationship to the Family in Need
Primary Family Contact Persons Name (Parent or Guardian)
Primary Family Contact Persons Date of Birth (Parent or Guardian)
MM
/
DD
/
YYYY
Primary Family Contact Person's phone number (Parent or Guardian)
Primary Contact Address (Parent or Guardian)
Primary Family Contact Person's email (Parent or Guardian)
What is the best way to contact the Primary Family Contact Person (Parent or Guardian)?
City that the family lives in:
Please list the First Name, Last Name, Age for ALL Children living in the home (Ages 0-18):
Please tell us the school district the child(ren) attend.
What specific schools do the children attend in the district (Please list all schools if more than 1).
Please check all boxes of the immediate needs or barriers that the family is experiencing.
Other information you would like to share about the family's needs?
Where did you hear about our services?
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