Peer Advocates Referral Form

PLEASE NOTE: PAs can only assist in the following advocacy areas: employment, education, housing, reproductive health, and AB12 consultant. If you have questions, please contact Erika Murillo at murilloe@clccal.org.

Dependency Contact Information
Referral Information
Gender
Race/Ethnicity
Check all that apply.
Which areas of advocacy does your client need assistance in?
Check all that apply.
Please provide the following information about the young person you are referring.
Upcoming Court Dates (if known)
Does this young person have an active court case?
Additional CLC Information
Conflict CLC Firms
Do you have a Word/PDF copy of the last court report? Please note: Reports should only be updated if the report is not accessible in the court portal.
One file only.
8 MB limit.
Allowed types: gif jpg jpeg png pdf doc docx.