ECYEH Referral Form
Education for Children and Youth Experiencing Homelessness (ECYEH) works to remove barriers for students experiencing homelessness/housing insecurity/displacement in Philadelphia. Please fill out this form and we will contact the student/family or we will have the counselor or charter school liaison contact the student/family.  You can contact us directly @ ecyeh@philasd.org.  For more information visit philasd.org/homeless.
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Email *
Name of person submitting referral *
Which one describes you? *
Name of parent/guardian OR unaccompanied *
Student Name #1 *
Student Name #2
Student Name #3
Student Name #4
Student Name #5
If the family has more than five children, we will take this information when we contact the family.
Phone number to contact student/family
Email to contact student/family
Preferred language
Information for ECYEH to be aware of prior to reaching out to the student/family
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