Refer A Child – House of Compassion

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Our Program
Impact
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REFER

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Home
Our Program
Impact
Donate
About Us

Home
Our Program
Impact
Donate
About Us

REFER

contact

Facebook-f Instagram

Home
Refer A Child

STEP 1

COMPLETE THE FORM

You will be contacted within 24 hours of your submission to schedule a consultation.

STEP 2

CONSULTATION

Our program coordinator will schedule a call to gather more information on your teen.

STEP 3

MEET & GREET

Your teen will have a brief tour and interview with our house manager.

STEP 4

COORDINATE INTAKE

If your teen is accepted, you will be contacted by our team to schedule intake!

HOC Referral Form

What is your relationship to the youth you are referring? *

How are you related?

What is your name? *

First

Last

What agency are you from? *

Who should we contact for additional information?

Email *

Phone

Youth Info

Youth Full Name: *

Date of Birth *

Reason for referral?

Current Placement? *

When is placement needed?

Which behaviors are a concern in the home/placement? *

Physical Aggression
Verbal Aggression
Running Away
Theft
Struggles with Boundaries
Self Harm
Drug Abuse
Difficulty with Authority

Current School

Current Grade

Select the following services that are currently in place or that are needed:

Psychiatric Services
Individual Therapy
IEP or 504 education plan
Life Skills Training

Rate School Performance

Average/above average performance overall
Good grades but behavior is concerning
Poor grades but no behavior concerns
Grades & behavior are concerning

Do you know a youth in need?

Get in touch with us on ways we can help.

T: 816-761-CARE (2273)
F: 816-256-5862

Address:

13900 Southern Rd
Grandview, Missouri 64030

Career Opportunities:

Learn more about employment and volunteer opportunities here.

Refer A Child

Forms