Refer a Youth Your Name(Required)Your Email(Required) Name of Person to contact for CTRAC services(Required)Phone number of contact person(Required)Email of contact person(Required)Your relationship to the youth(Required) Parent or caregiver Legal representative Educator Caseworker Therapist Other Your professional organization / company name (if applicable)Youth's name(Required)Youth's Date of Birth(Required)Is the youth between the ages of 8-18?(Required) Yes No This youth is not eligible for Project Justis. If you would like more information about referring a youth to CTRAC outside of Project Justis, please email us at ctrac@colostate.edu or call (970) 491-5093.Do you hold medical decision making for the youth?(Required) Yes No If yes, do you hold joint, sole, or temporary?(Required) Joint Sole Temporary If not, who holds medical decision making for youth?(Required)If yes to joint, with who?(Required)Has the youth ever been arrested or involved in the juvenile justice system?(Required) Yes No One of the criteria for involvement in Project JUSTIS is past or current involvement in the juvenile justice system or the presence of risk factors for involvement in juvenile justice. Based on your knowledge of the youth, let us know if any of these risk factors are present. If you aren’t sure, please select “I’m not sure.” We will follow-up about these experiences further during an intake call.(Required) Past or current involvement in JJ, such as an arrest or criminal charge Personal use and/or positive attitude about drugs or alcohol Peer use and/or positive attitude about drugs or alcohol Truancy, negative attitude about school, and/or dropped out of school Aggressive behaviors in childhood Poor impulse control and/or sensation seeking behaviors Association or friendships with delinquent and/or gang involved peers Involvement with a gang Family history of criminality or arrests Poor family relationships, including violence, physical punishments, and/or low parental monitoring High levels of crime and/or lack of safety in the neighborhood/community I’m not sure if the youth has any of these risk factors Other Please write in other risk factors(Required)Another criteria for involvement in Project JUSTIS is exposure to at least one potentially traumatic event. Based on your knowledge of the youth, let us know if the youth has experienced and/or been exposed to any of the following events. If you aren’t sure, please select “I’m not sure.” We will follow-up about these experiences further during an intake call.(Required) Physical abuse Neglectful home environment Emotional abuse Exposure to domestic violence Exposure to other chronic violence Sexual abuse or exposure Parental substance abuse Impaired parenting (mental illness) Exposure to drug activity aside from parental use Pre-natal exposure to alcohol drugs or maternal stress during pregnancy Lengthy or multiple separations from parent Placement outside of the home (e.g., foster care, kinship care, residential placement) Loss of significant people and/or places Frequent/multiple moves or homelessness I’m not sure if the youth has experienced any of these events Other Please write in traumatic event(Required)What is the preferred location for services?(Required)Select oneCSU Fort CollinsCSU Spur in DenverNo preference
