When starting, please be prepared to complete the form in one sitting. Information will be saved from tab to tab but if you close the browser part way through, or reload the page, information will be lost and you will have to start again. All fields are mandatory.

If you do not get confirmation of receipt for the referral within 5 business days, please email: youthadvocateprogram@halifax.ca

Consent

You are sharing personal and private information about this family and youth. Please speak with the parent/guardian and youth to explain the program and referral process before proceeding. If you, the parent/guardian, or youth have any questions before moving forward, please reach out to the Intake & Assessment Coordinator using the email or phone number given.