Request edit access
The Youth Justice Project Virtual Intake
We hope you are remaining safe during this COVID crisis. If you are between the ages of 16 and 24 and were referred to the Youth Justice Project, or are unsure how to go through our general intake process, please fill out this brief form and we will reach out within one to two business days.

If you are outside of this age range, please call Community Legal Services' general intake hotline at 215-981-3700.
Sign in to Google to save your progress. Learn more
Email *
Who is this referral for? 
Clear selection
Name *
Other names you use/ have used in the past
Pronouns
How can we support you?
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Phone Number *
Is there someone else we can contact if we can't reach you? What is their email address or phone number?
Preferred Method of Contact
Clear selection
Do you live in Philadelphia?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Community Legal Services.

Does this form look suspicious? Report