HELP – Agency Referral | HELP INC

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Agency Referral

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Parent/Guardian Advisor Client

Agency Name *

Address

Phone Number

Name of Advisor *

First

Last

Email *

Client Name *

First

Last

Address

Date Of Birth

Telephone number

interpreter needed? what language? *

Details of Client's Need

Reason for Refferal

Parent/Guardian Name *

First

Last

Parent/Guardian Address

Parent/Guardian Phone Number

Parent/Guardian Phone Number Secondary

H.E.L.P Service

From mental health support to job placement services, H.E.L.P. Inc aims to bridge the gap for our youth. Our goal is to setup our participants with a system of success and long lasting positive changes.

24/7 Support!

Here at H.E.L.P., we provide 24/7 direct support and resources to support K-12 youth and young adults who are experiencing difficult life circumstances

The H.E.L.P Vision

Our vision is to eliminate gang and gun violence so every young person can safely live their life’s purpose.