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Refer a Youth to Rogue Valley Mentoring
Please let us know who we can reach out to, and what they are interested in!
RVM's Match Specialist, Chelsea Beeler, will reach out to the family to follow-up.
Our Mentor/Youth Support Specialist, Lynn Chertkov, MSW, will reach out to any referring healthcare providers if there are specific questions or concerns.
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Referring Agency
Your answer
Referring Party Name
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Your answer
Referring Party Contact: Phone or Email
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Your answer
Interested Youth's Full Name
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Your answer
Interested Youth's Birthdate
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Interested Youth's Gender
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Interested Youth's School
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What RVM programs is the youth interested in? Please, check all that apply:
1-to-1 Mentoring (Ages 9 - 24 year old youth)
Youth Leadership Advisory Board - YLAB (11 to 21 year old youth)
Free To Be! - LGBTQ+ Youth Support Circle (high school youth)
D.R.E.A.M. After-school Program at Spartan Boxing (middle school youth)
Other:
Interested Youth's Parent or Guardian
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Parent or Guardian's Phone Number
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Your answer
Parent or Guardian's Email
Your answer
Is there anything else RVM should know about this referral?
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By submitting this form, you give permission for Rogue Valley Mentoring to contact the parent or guardian of the interested youth regarding this opportunity.
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