Youth Services Referral Form

Our Youth Services Program are for youth ages 11 and 21.

  • Youth ages 16–21 who are in foster care or in the custody of the state are eligible for housing

  • Youth ages 16–17 who do not have a safe place to stay (homeless or runaway) are eligible for housing

  • Families with youth 11- 21 who are having a hard time adjusting to changes at school, home, or in life may be eligible for case management services.

  • Youth who 11-21 who are being released from detention, secure or a non-secure placement are also eligible for case management services.

If you need help, you can fill out the questions below to apply for our program. 

After we get your application, someone from our team will contact you within 3 business days.

We’re here to help you. Thank you for reaching out to Youth Oasis!

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Email *
How did you hear about Youth Oasis? *
Today's Date *
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Participant's First Name: *
Participant's Last Name: *
Date of Birth:  *
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How should we contact you?  *
Provide contact information:  *
Household Size: *
Required
Gender *
Required
Select your needs from the list below:  *
Required
Have you been arrested within the last 6 months? *
Are you currently on probation/ parole?  *
Were you released from a secure/ non- secure correctional setting within the last 6 months (including detention)? *
Are you scheduled to be released from a prison, jail, detention center or nonsecure placement within the next 90 ays? 
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Are you receiving services through any other Youth Oasis program? *
Are you currently in foster care or extended foster care? *
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