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What type of program/service do they need?

(Select one category below)

• Mental / Behavioral

  Mental / Behavioral

  • Acting emotionally detached or unable to connect well with others.
  • Having trouble paying attention or focusing.

  • Having problems sleeping or having bad dreams.
  • Reporting frequent headaches or stomach pains.

  • Not enjoying hobbies or interests.
  • Feeling depressed, anxious, or overwhelmed.
  • Having thoughts about hurting themselves or others.

  • Not enjoying hobbies or interests.
  • Feeling depressed, anxious, or overwhelmed.
  • Having thoughts about hurting themselves or others.
• Developmental / Intellectual Disabilities

  Developmental / Intellectual Disabilities

  • Not meeting typical developmental stages or milestones.
  (i.e. not doing or delayed in sitting up, crawling, walking, or talking)

  • Struggling with learning, language, daily interactions, or behavior.

  • Struggling with learning, language, daily interactions, or behavior.

  • Struggling with learning, language, daily interactions, or behavior.
• Medical / Physical

  Medical / Physical

  • Being sick or seeking medical care often.

  • Being sick or seeking medical care often.

  • Being sick or seeking medical care often.

  • Being sick or seeking medical care often.
• Alcohol / Substance Use

  Alcohol / Substance Use

  • Showing sudden changes in mood and behavior.
  • Changing friends, favorite activities, or hobbies.

  • Showing sudden changes in mood and behavior.
  • Changing friends, favorite activities, or hobbies.
• School / Learning

  School / Learning

  • Trouble focusing, learning, doing school work.
  • Having a hard time making friends/interacting with peers/adults.
  • Problems with behavior.

  • Trouble focusing, learning, doing school work.
  • Having a hard time making friends/interacting with peers/adults.
  • Problems with behavior.

  • Trouble focusing, learning, doing school work.
  • Having a hard time making friends/interacting with peers/adults.
  • Problems with behavior.

  • Trouble focusing, learning, doing school work.
  • Having a hard time making friends/interacting with peers/adults.
  • Problems with behavior.
• Basic Necessities

  Basic Necessities

  • Not having a stable place to live or access to health care, dental care, food, or clothing.
  • Not feeling safe in their home environment.

  • Not having a stable place to live or access to health care, dental care, food, or clothing.
  • Not feeling safe in their home environment.

  • Not having a stable place to live or access to health care, dental care, food, or clothing.
  • Not feeling safe in their home environment.

  • Not having a stable place to live or access to health care, dental care, food, or clothing.
  • Not feeling safe in their home environment.
• Child Care

  Child Care

  • Not having access to quality, affordable child care.

  • Not having access to quality, affordable child care.
• Housing / Independent Living

  Housing / Independent Living

  • Experiencing homelessness or being at risk of losing a place to live.
  • Not having the equipment, services, or resources to live independently.

  • Experiencing homelessness or being at risk of losing a place to live.
  • Not having the equipment, services, or resources to live independently.
• Family / Youth Support & Peer Advocacy

  Family / Youth Support & Peer Advocacy

  • Lack support from family/friends during stressful times/situations.
  • Not being able to ask for help/share needs/challenges.

  • Lack support from family/friends during stressful times/situations.
  • Not being able to ask for help/share needs/challenges.

  • Lack support from family/friends during stressful times/situations.
  • Not being able to ask for help/share needs/challenges.

  • Lack support from family/friends during stressful times/situations.
  • Not being able to ask for help/share needs/challenges.
• Employment Services

  Employment Services

  • Having trouble finding, getting, or keeping a job.

  • Having trouble finding, getting, or keeping a job.