Residential

Residential Referral

Provide background, contacts, behavioral history, and supporting documentation. Our admissions team reviews each referral and follows up with the case manager directly.

Basic Information

Child Name*

Date of Birth*

Gender*

Home Circuit*

Legal Status*

Current Placement*

Length of Time in System of Care and Number of Previous Placements*

Referral & Case Contacts

Case Manager Name*

CMO Name*

Case Manager Email*

Case Manager Phone*

Other Primary Contacts

Guardian ad litem, bio family, etc.

Family & Support System

Family Relationships and Support Systems*

Behavioral Functioning

Current Behavioral Functioning*

Patterns, top concerns, recent incidents, triggers, and what interventions work or don't.

Response to Structure and Authority*

Education

Current School, Grade, IEP/504 Status, Attendance, and Engagement*

Medical & Clinical

Special Medical Needs*

Medications, Dosage, Compliance, Last Med Mgmt Appt*

Safety & Risk Factors

Existing Safety Plan or Restrictive Placement Agreements*

Current Safety Concerns*

History of Fire-Setting, Harm to Animals, or Sexualized Behaviors*

Gang Affiliation or Negative Peer Influences*

Legal / DJJ

Current or past DJJ involvement?*

Strengths & Motivation

Strengths, Motivations, and When the Youth Is at Their Best*

SailFuture Fit

Awareness of and Interest in SailFuture*

Including comfort with international travel and water-based experiences.

Why SailFuture, Why Now*

Fit rationale, hopes for the program, and any concerns or known risks.

Supporting Documentation

Files upload immediately; please wait for the green confirmation before submitting.

CBHA*

Additional CBHA Information or Notes

Additional DJJ Information or Notes

Comprehensive Placement Assessment*

CPA Notes

Progress saves automatically in this browser. Required fields marked with *.

Residential

Residential Referral

Home

Get Involved

Academy