SNAP® Referral Form
What is SNAP®?
SNAP® stands for STOP-NOW-AND-PLAN and is an award-winning, evidence-based program that teaches children and families effective strategies for dealing with behaviors such as lying, stealing, talking back, bullying, defiance, and more. Watch the video below to learn more about the SNAP® process.  

To refer a child to Auberle's SNAP® Program: please fill out the form below and a staff member will be in touch. If you have any questions regarding the referral process or would like to sign up via phone, please contact the SNAP® Program Manager, Megan Matejcic, at (412) 673-5800 x1279 or meganm@auberle.org.

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SNAP® Services - What to Expect
FAMILY INFORMATION
Child Name *
Child Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian E-mail *
Parent/Guardian Address
Select the top three presenting issues at the time of referral: *
Required
REFERENT INFORMATION
If you are the child's parent/guardian and making a self-referral, you may skip this section.
Your Name
Your Agency/Organization
Your Phone Number
Your E-mail
Your Relationship to the Child Being Referred *
How did you hear about the SNAP® program? *
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