Referral Forms

Family Mentor

FAMILY MENTOR REFERRAL. Complete our Family Mentor Referral Form. Once completed it will be sent to our team member, Kristi Varnum (

Prosper Placer

Please CLICK HERE to LEARN about the role of a Prosper Placer “Change Leader” (participating family). To APPLY to become a Change Leader, fill out an APPLICATION form by filling out the form.

To become one of the Prosper Placer “Allies” (Community Volunteers), CLICK HERE for the application form.

For more information, contact Program Supervisor Katja Pollmann at, Frida Diaz at, or call our office: (530) 887-1006.


To refer these youth, please fill out the BE BOLD Youth Program Referral Form.  A Program Manager will contact you about your youth’s needs and their eligibility for the program. 

Complete our BE BOLD Referral Form.  Once completed, it will be sent to our BE BOLD Youth Program Managers Taylor ( and Jason (  You can reach them at (530) 887-1006 or by email.

BE BOLD Youth Program also serves youth not involved with CPS/Probation, but are in need of LGBTQIA+ support or are displaying any of the following behaviors: Cognitive Delays, Physical Disabilities, Severe Self-Harm, Physical Aggression, Sexually Acting Out, Suicidal Ideation and Addiction.