Referral Page

Now accepting mentees and clients to our CM-FIT model therapy. If you know of anyone youth from the ages of 13 – 24 years old. Please contact us and see how we can help.

Appropriate CM-FIT Referrals (Limited Caseload)

Youth that are gang-involved / members will be prioritized
Youth with gun- or weapon-carrying charges
Youth with assault charges, drug possession / use / abuse
Chronic behavior problems at school

Appropriate Mentoring Referrals

Must be gang involved or affiliate
Must be willing to join our group
Available to meet once a week at our weekly group sessions

EL PUENTE

CM-FIT Referral Form

El Puente Tri-Cities

1009 Center Parkway 3525 E A St

Kennewick

WA 99336 Pasco WA. 99301

C: 509-410-5628 E: info@elpuentetc.org

Youth's Full Name

Youth Date of Birth

Month

Day

Year

Youth's Phone Number (please add a 1 before phone number)

Youth's Address

___________________________________________________________________

Person Making Referral

Person Making Referral's Email

Person Making Referral's Phone Number (please add a 1 before phone number)

___________________________________________________________________

Parent / Guardian Name(s)

Parent / Guardian Phone Number(s) please add a 1 before number(s)

Parent / Guardian Home Address(es)

Parent / Guardian Job(s)

___________________________________________________________________

Emergency Contact Full Name

Emergency Phone Number (please add a 1 before phone number)

Relationship to Youth

___________________________________________________________________

Reasons for Referral (e.g. behavior, legal involvement, etc.)

Has Family been told about this referral?

Yes

What Goals would like to achieve?

Are there other community supports for this youth (e.g., faith groups, sports activity, etc.)