Youth Homes Application Name of contact* Contact's location* Relation to child* Child's location* Phone* Email* Child's name* Child's age & grade* Select one for child* Female Male Legal guardian(s) of child*Reason for referral (Check all that apply)* Home or neighborhood environment is not healthy or safe Financial needs of family Child needs change of educational setting Child needs more structure or supervision Child needs change of environment Child has emotional or behavioral needs Child needs counselling To ensure graduation of child Other Is there anything specific you wish to tell us about this child or this situation?*How did you hear about NMCCH?Disclaimer NMCCH is not a rehabilitation center or a residential treatment center, nor is it a boarding school. We focus our ministry to those children whom we can best serve with the resources, facilities, and child care training and expertise available to our staff. Limiting factors for admission to NMCCH Youth Homes include: Severe or profound cognitive impairment or intellectual disability Severe or profound physical impairment or disability Drug or alcohol use that requires rehabilitation treatment Mental or emotional health status of suicidal, psychotic, emotionally disturbed or otherwise in need of psychiatric hospitalization History of or current involvement with the juvenile justice system History of arson History of cruelty to animals Active affiliation and/or participation in a gang Current pregnancy Δ
