Child Advocate Referral

Child Advocate Referral

Child Advocate Referral

Enter the information below to refer a child for Child Advocate services.

Referred By Information

Name of Referrer:

*

Email:

*

Title:

*

Phone Number:

*

Relationship of Referrer to the UC:

*

Date of Referral:

*

Young Center Team Closest to Child:

*

Note:

The New Jersey Released team works only with children who are released from ORR custody into the New Jersey community. If a child is in ORR custody in New Jersey, please refer them to the New York City team.

Child's Information

If you do not have the information below, please enter "unknown."

First Name:

*

Middle Name:

Last Name:

*

Sex assigned at birth:

*

Gender Identity Definitions

Cis male: A person who was assigned male at birth and whose gender identity is male.
Cis female: A person who was assigned female at birth and whose gender identity is female.
Trans male: A person who was assigned female at birth but whose gender identity is male.
Trans female: A person who was assigned male at birth but whose gender identity is female.
Non-binary: An adjective describing a person who does not identify exclusively as a man or a woman. Non-binary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories. While many also identify as transgender, not all non-binary people do.
Gender nonconforming: A broad term referring to people who do not behave in a way that conforms to the traditional expectations of their gender, or whose gender expression does not fit neatly into a category.

Gender identity:

*

Identifies as part of the LGBTQIA+ community?

*

Birth Date:

*

Age:

Languages Spoken (Reminder: You may select ALL that apply):

*

What language does the child prefer to speak?

*

A#:

*

Nationality:

*

Is this child in ORR custody?

*

Previous Facility?

*

Date of DHS Apprehension:

Date of most recent entry into ORR custody (regardless of if the child was re-apprehended):

*

Date of UC's Arrival at Care Provider:

*

Does the child have legal representation (G28 or E28 on file)?

*

Checklist

Please complete all.

Child was Separated from a Parent at the Border:

*

Is Between the Ages of 0-12:

*

Is Placed in a Residential Treatment Center or Therapeutic Facility:

*

Is Pregnant:

*

Is Parenting:

*

Has a Physical or Mental Disability:

*

Is a National from a Country Known to Traffic Children:

*

Has been Identified as Possible Child Trafficking Victim (Interim Assistance Letter, Eligibility Letter, etc.):

*

Has a Criminal or Delinquency History:

*

Is Placed in a Staff Secure Care Provider or Secure Care Provider:

*

Has been a Victim of a Crime:

*

Is Expected to have a Protracted Stay of Over 120 Days in ORR/DUCS Custody:

*

Is not Proficient in a Language Spoken by Staff at the UC's Care Provider, and for whom there is no Accessible Interpreter Routinely Available:

*

Will Turn 18 in less than Six (6) Months of Placement and for whom Family Reunification is Unlikely:

*

Is Identified as Being Eligible for Legal Relief:

*

Has a Credible Fear of Returning to their Country of Origin:

*

Is Seeking Voluntary Departure Despite Concerns about their Safety in their Home Country:

*

Lacks Appropriate Legal Representation, or for whom there is a Good Faith Belief that the Child's Legal Representative has Ties to Child Trafficking or Criminal Activity:

*

Potential Sponsor is Undergoing a Home Study:

*

Is Unable to Make an Independent Decision:

*

Any Other Case where the UC is Considered to be Exceptionally Vulnerable:

*

Explain Here:

TYC Portal

Child Advocate Referral

Child Advocate Referral

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