PVPSA | Santa Cruz County Thriving Youth and Community Referral Form

Santa Cruz County Thriving Youth and Community

MIDDLE AND HIGH SCHOOL REFERRAL FORM

CONFIDENTIAL

This is a confidential form. Completion of this form signifies your concern for the health
and wellbeing of a Santa Cruz City Student. Those who refer will remain confidential.

Informational materials: Program Brief; Informational Flyer

Informational Video (English)

Informational Video (Spanish)

Services Being Requested

Pathway one - Prevention: Stanford prevention toolkit
Pathway two - Intervention: Seven Challenges group sessions
Pathway three - Cessation: Project EX group sessions

**All pathways integrate positive youth development programming with Invincible Youth (IY) with
additional skill building and youth leadership opportunities with Friday Night Live (FNL).

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