JustUs Referral
A Brooklyn-based gender-diversion demonstration project for young people
Name & Title
What agency do you represent? *
Provide a phone number and/or email
of the young person
of the young person
Best Method of Contact *
of the young person
- Phone
- Text
- Email
- Facetime Audio
- Facetime Video
- WhatsApp Audio
- WhatsApp Video
- Other
for the young person (number or email)
Brief reason for referral *
Why are you/the young person interested? PLEASE DO NOT INCLUDE NAMES
- {name}
What does the young person know about the referral you are making? *
PLEASE DO NOT INCLUDE NAMES
- {name}
Justice System Involvement *
(In order of increased legal involvement)
- No Legal Involvement
- Probation Adjustment
- Corp Council Diversion (no open court case)
- Open Delinquency Court Case
- Probation Supervision
- Open Youth Part Court Case
- Open Criminal Court Case
- Past Legal Involvement
- Unknown
Child Welfare Involvement *
- None
- Open CPS case – Parent
- Open CPS case - Youth
- Preventive
- Court Ordered Supervision
- Foster Care
- FAP
- JJI
- Unknown
Other system involvement (if any) *
- {name}
if there isn't one, please write "N/A"
Mandate Information *
enter "N/A" above if this does not apply
Attach file
Drop files here
Is there a court mandate for this young person? *
- Yes - court mandated
- No - strongly recommended (participation has direct implications for court involvement or incarceration)
- No - suggested
- No - voluntary
- Other
How did you hear about JustUs? *
- Word of Mouth/Community
- Friend in JustUs
- Partner/Nonprofit Provider
- Recruitment Video
- Court/Lawyer
- Colleague/Coworker
- Other
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