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ADMISSION FORM (Full Intake)h

Section 1: Contact Info


Section 2: Youth Information


Section 3: Referral & Legal Status


Section 4: Behavioral & Clinical Overview

's behavioral & clinical details


Section 5: Medical & Support Needs


Section 6: Additional Information


FREQUENTLY ASKED QUESTIONS

Frequently Asked Questions

Who can submit a referral or admission inquiry?
Parents, guardians, case managers, DSS workers, and other agency representatives can all submit referrals. We accept inquiries from both families and professionals involved in the youth’s care.
What information is required to start the admission process?
Only basic contact details and a few quick questions are needed in Step 1. The full admission form (Step 2) gathers additional information about the youth’s needs, placement history, and support requirements.
How long does it take to receive a response after submitting a referral?
Our team typically responds within one business day. If the referral is urgent, we prioritize communication and follow up as quickly as possible.
Do you accept youth with behavioral or legal challenges?
We review each referral individually. Many youth we serve have behavioral, emotional, or legal challenges, and our program is designed to support structured care. The admission form helps us determine whether our program is the right fit.
What happens after I submit the full admission form?
Our admissions team reviews the information, contacts you for any needed clarification, and discusses next steps. If the youth is a good fit, we move forward with placement coordination and scheduling.
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Level 3 Residential Group Home

Contact Info

Mount Holly 28120, Gaston County, North Carolina, US