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 & Long Term Human Trafficking Service Provider serves ladies.

Point Of Contact/Guardian Info


Youth / Young Adult Information (we serve ages 13-24)

Note: If in foster care: please send over all of youth records to:


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
Case Mgt Support
CSEC services/ survivor mentorship


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