Referral Form for The Brave House
This form is for attorneys, social workers, and other advocates in NYC who would like their client to become a member of The Brave House community! Once we receive a referral, we will contact the young person to welcome them into our Brave House community.

Your client is eligible to join The Brave House if:
1. They are between 16-24 years old;
2. They identify as female or are gender-non-conforming; and
3. They were born outside of the United States

We offer a wide range of free services, including:
1. Immigration Legal Support (on case by case basis for those under 21)
2. English Lessons
3. Mentorship Program
4. Career Advising / Resume Writing
5. Health Insurance Enrollment
6. Community & Wellness Events such as art therapy, mindfulness & meditation, dance class, self-defense class, indoor rock-climbing, college campus tours, museum visits, and more!  

At The Brave House, we love to encourage self-advocacy. If your client is interested in joining our community please encourage them to sign up here: bit.ly/brave-house-membership  If they’re unable to sign up on their own please fill out this form for them. Thank you!
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Email *
What is your name & relationship to the young woman or GNC youth? (Ex: Name, Attorney) *
What is your e-mail? *
What organization are you a part of? *
What is the young woman or GNC youth's first name & last initial(s)? (Ex: Maria R.S.) *
How old is she/they? *
What country was she/they born in? *
What language(s) does she/they speak? *
Required
What county does she/they currently live in? *
Is she/they seeking legal representation? *
If applicable: What type of immigration case does the young woman or GNC youth have?
Clear selection
If applicable: Is she/they in removal proceedings?
Clear selection
What services/class is she/they interested in joining? *
Required
Did you already speak to the young woman or GNC youth about our services? *
Please provide a phone number for the young woman or GNC youth so that we can contact them. *
Please provide an email for the young woman or GNC youth so that we can get started! *
If the young person does not have an email account please write N/A
Is there anything else you would like us to know before we reach out to her/them?
Do you have any ideas for programs / collaborations?
Submit
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