Referral Application

 

REFERRAL APPLICATION

 
Completion of the below application “confirms/enables” consent to allow the referring agency to provide the following information to The Secret Place Home, Inc. in consideration for one of The Secret Place Home's service offerings. The Secret Place does not discriminate based on the responses provided on this form. Please be truthful, factual, and provide complete responses.
 
The Secret Place Home, Advocate Center & CSEC Service Provider serves young ladies age 12-25 years

Point Of Contact/Guardian Info

 

Youth / Young Adult Information (we serve ages 12-25)

Note: If in foster care: please send over all of youth records to: Alicia.tappan@thesecretplacehome.org

 

Individual/Group Counseling
Equine and/or Art Therapy
Independent Living: Drivers Training, Career Exploration, domestic life skills, health & wellness
Education/GED, College Prep
Victim Services/Legal Services
Food
Case Mgt Support
CSEC services/ survivor mentorship

 

Support/Encouragement
Food
Family Counseling
Drivers Education
GED/College Prep
Domestic Life Skills
Transportation
Victim/Legal Services
Adult Case Mgt- WIC, Financial Asst, Career Exploration, etc.
Childcare referral