Life Program Referral

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Life Program Referral

HYT Program Eligibility

Healthy Youth Transitions (HYT)

To be eligible youth MUST be between the ages of 15-22 and be a Broward County Resident. HYT programs are designed to provide life coaching services for transitioning youth in the following target populations:

Youth must be:

• Adjudicated dependent youth in out of home care or youth placed in protective supervision
• Youth who are in non-adjudicated relative or non-relative caregiver living arrangements
• Middle or high school aged youth with delinquency involvement
• Middle or high school aged crossover youth with delinquency and dependency involvement
• Middle or high school aged youth who identify as Lesbian, Gay, Bi-sexual, Transgender and Questioning (LGBTQ) and who are at high risk and in need of life coaching services.

** Youth who are participating in any Healthy Youth Transitions (HYT) program cannot be dually enrolled in another CSC/HYT program occurring during the same time period.

JAG Program Eligibility

Justice Assistance Grant (JAG)

The JAG Program is designed to provide services to youth who meet the following criteria:

• A Broward County Resident
• Between the ages of 14-21
• Have been served by the Broward County Juvenile Predisposition Services (JPS)
• Adjudicated Dependent and have been involved with the Juvenile Justice System

Life Program Referral

Date*
Select Program*
Name*
First Last
Student ID#*
Age*
Gender
Date of Birth*
SSN#*
Race
Ethnicity
School*
Grade*
Caregiver's Name*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number in Household*
Teen Parent
- Yes
- No
Choose One: Youth Living Arrangement*
- Relative
- Non-Relative
- Parent
- Foster Care
- Displaced
- Homeless
Person Referring Youth:
Referrer's Name*
Agency*
Referrer's Phone*
Referrer's Fax
Referrer's Email*
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