Referral Forms

Referral Forms


Final Placer Mentor Logo

PLACER YOUTH MENTORS: Please CLICK HERE to complete the Placer Youth Mentor Referral Form. The referral form will automatically be sent to Jose Huizar (

FAMILY MENTORS: Please CLICK HERE to download our Family Mentor Referral Form. You must first save the document to your computer to be able to fill in the information. Please email your completed form to Jamie Nichols (


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 a APPLICATION form by CLICKING HERE.

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

For more information about Prosper Placer, contact Katja Pollmann: or Frida Diaz:

If you have any questions please contact us at (530) 887-1006.

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