True North Youth Program Student Nomination
Thank you for taking the time to connect True North Youth Program with regional youth! Please complete the following questions for the student you would like to refer to True North. We will then follow up with you if needed and make outreach to the parent and student. 

Please contact us if you have any further questions or would like to meet in person to discuss how we can best support this student!

Contact: truenorthyouthprogram@gmail.com or 970.708.1986
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What is your name? *
What is your contact info? Phone and Email, please. *
What is your preferred method of contact? *
What is your relationship to the student? *
Would you (referring individual) be willing to act as a liaison with the family to make an introduction and help get a True North application and waiver completed? If not, who should we enlist to help?
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What is the student's full name? *
What is the student's contact info? (email and/or phone) *
What school does the student attend?  *
What grade is the student currently in? *
Parent/Guardian Names & Contact Information (Email & Phone) *
Where does the student live? *
Why are you making this referral? How does the student experience limited access to any of the following: resources, opportunities, advocacy, and support? 
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What strengths does the student possess? 
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What do you hope this student will gain from their involvement with True North? What outcomes do you expect from their participation in programming? 
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Who else is supporting this student (agencies, individuals, programs)
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Anything else about the student that would be helpful to know: 
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