Youth Violence Prevention Program Referral Form
The City of Aurora Youth Violence Prevention Program is accepting referrals for at-risk youth who would benefit from case management services. Completed referrals will be sent to our in-house case manager for triage and further assistance. 
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Referral Agency Name: *
Name of Individual Referring the Youth: *
Reason for Referral: *
Email of Individual Referring the Youth: *
Phone Number of Individual Referring the Youth *
Full Name of Youth: *
Phone Number of Youth:
Email of Youth:
Name of Parent/Guardian:
Phone Number of Guardian:
Email of Guardian:
Other Important Contact Information:
Check all the following resources that the youth may need:
Is there any other background information that the case manager should know about this youth? This could include past involvement with law enforcement, judicial services, current legal issues, living situation, physical or mental health concerns, and the youth's motivation to engage and receive services.  *
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