HPA Referral Form

Please note our program eligibility criteria before submitting a referral. Clients who do not meet the following will not be eligible for HPA services.

  1. CLC NMD-TAY Client of CLCLA
  2. 18-20 years of age
  3. 90 days prior to 21st birthday
  4. Homeless/unhoused
  5. At-risk of being homeless
  6. Recently housed and/or in transition
Dependency Contact Information
Referral Information
Please provide the following information about the young person you are referring.
Check all that apply.
Need and Characteristics
Check all that apply.
Check all that apply.
Additional CLC Information
Referral History
Indicate youth interest in the program (i.e., referral outcome)