Oasis Youth Care: Referrals & Pre-Intake

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Oasis Youth Care Programs is dedicated to supporting vulnerable and racialized youth facing barriers on their journey to independence and competence.

Please complete this form with accurate information. It should take 2 minutes. Thank you!

Email *

Please select which applies:

I am a Caregiver/Community Advocate/Caseworker referring a youth

I am self-referring as a Youth

Clear selection

Full Name

Relationship to youth being referred:

Parent

Caregiver

Mentor

Caseworker

Not Applicable

Other:

Clear selection

First & Last Name of Youth

Age of Youth

Date of Birth *

YYYY

Which Region is Youth (you) currently resident:

Halton

Peel

Hamilton

Other:

Clear selection

Does youth racially identify as a visible minority? *

Yes

Other:

Which services are you seeking from Oasis Youth Care? (Select all that apply)

Transitional Housing

Life Skills Training / Coaching

Culturally Competent Mentoring

Other:

Is youth legally allowed to work in Canada?

Yes

I don't know

Clear selection

Support Services: Please check ALL that apply to the youth in the list below.

Currently has a safe and stable place to live.

Has adequate transportation to school, training and work

Has a valid driver’s license.

In good physical and mental health.

Has a criminal background that may or may not impact the ability be supported

Will need housing and transportation support

A mentor will be valuable

Will need support services for mental health and overall wellbeing

None apply

Other:

FOR REFFERALS ONLY - Is youth aware of this referral?

Yes

Maybe

Clear selection

When would youth be ready to access services?

Immediately

In 3 months

In 6 months

Other:

Clear selection

Can we contact you directly? *

Yes

Not sure

If yes, please provide the best contact

Today's Date *

YYYY

Submit

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