Canadian Citizen Youth Referral Application
Please do your best to provide the most accurate and up-to-date information as possible.

WHO SHOULD COMPLETE THIS FORM?
Only a worker from an organization currently involved with the Canadian youth (e.g. health practitioner, school board, etc.) can complete this form.

CANADIAN CITIZEN YOUTH CRITERIA
– Born in Canada
– ages 6 -15

THE MATCHING PROCESS
The match with a volunteer is based upon common interests, compatibility and close proximity to one another. The Peer Project strives to promote diversity. We ask your cooperation in adhering to our Access & Equity Policy (which can be obtained upon request).

Email address *
I have read Google's Privacy & Terms policy (https://www.google.com/policies/), and understand that all the information I provide is confidential, subject to this policy *
Required
I am aware that this is the application for making a referral of a "Canadian Citizen Youth." *
Required
To refer a Newcomer Youth instead, follow this link:
Today's date *
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How did you first hear about The Peer Project? *
Required
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