GirlsFOCUSED - BoysFOCUSED Mentoring Project

~~Referral Form~~
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GirlsFOCUSED - BoysFOCUSED - is a ministry of FOCUSED Ministries, Inc. where our mission to provide support for girls and boys ages 13-18 to heal, grow, develop, and become the women and men God created them to be. Use this form is to refer a young person to be a part of the GirlsFOCUSED - BoysFOCUSED Mentoring Project and be paired with a responsible and caring adult.
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~~Note: All information is strictly confidential.~~

Mentoring Referral

Information about the young person being referred

Name

Nickname

DOB:

Current grade/school

Your relationship to the young person (Check all that apply):

Parent

Family Member

Teacher

School Administrator

School Counselor

Social Worker

Psycholgist

School Resource Officer

OtherOther

If you are not the parent, how long have you known this young person?

Is/are the parent(s)/guardian(s) aware of your referral?

Yes

Parent contact information:

As the referrer, please provide your contact information for future contact:

Name

Contact information: Home phone:

Cell Phone:

Email Address:

Preferred means/best time to contact you as a follow up, as needed:

Additional comments:

Thank you for referring this young person. We appreciate your care and concern for their well-being and growth. We also thank you for your consideration of GirlsFOCUSED - BoysFOCUSED and FOCUSED Ministries, Inc. as a resource to touch this precious life. We pray God’s blessings upon your life for taking this step on their behalf.
Please contact us if you have questions or concerns.
Downloadable Mentoring Referral Form

Connect with Us

FOCUSED Ministries, Inc. | P.O. Box 746 | Morton Grove, IL 60053
FOCUSED Ministries, Inc. TM is a faith-based - Non-Profit organization - 501(c)3 Federally Tax Exempt