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Our Advisors

Refer for Services

Please fill out this form to refer youth who could benefit from Project Rising Tide's initiatives. Your referral helps us expand our reach!

Referral Form

Your Information (Referrer)

Name*

Email*

Phone (Optional)

Individual Being Referred

Name*

Email

Phone Number

Relationship to Referred Individual*

Parent/Guardian

Probation Officer

Other

Reason for Referral

Please describe why you are referring this individual and how you believe Project Rising Tide can help them.*

I understand that by submitting this form, I am providing information about another individual and confirm that I have their consent to share their contact details with Project Rising Tide, or that it is appropriate to do so for the purpose of their well-being.

Terms & Conditions

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