TRAC Referral form

Any youth, aged 14-24, who is or has been in the care of the state can be referred to TRAC. Once we receive the referral, we will contact the caseworker first and then the caregiver to see how we can help the youth and what services will be appropriate for the youth. Please provide us with accurate information so we can start helping the youth get on track!

Please provide the following information:

Youth's Name
Youth's date of birth
Youth's gender
Youth's ethnicity
Youth's county of residence
Has youth emancipated from care?
Referring Source
Referring party's name
Phone
Fax
Email
PRS Caseworker/Probation Officer
Phone
Fax
Email
Caregiver name
Phone

Comments:

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