For Teachers

Do you have a student in your classroom who would benefit from the YouthBASE program?

  • Fill out the referral form. YouthBASE staff will contact you within 2-3 days upon receiving the information.
  • Please contact the child’s parent and tell them that you have referred their child to YouthBASE. You may send a child application form home after speaking to YouthBASE staff.
  • Parents are asked to bring the application to YouthBASE to meet our staff and attend a parent meeting.
  • Upon enrollment, parent will notify school of transportation change.
  • Call or email Syanya Valdovinos, Site Director, at svaldovinos@youthbase.org.

We want to partner with you. Staff will communicate with you to assess progress or needs, attain reading levels (quarterly), ask you to fill out a survey. Please do not hesitate to contact us if there is a way that we can support you. We appreciate all that you do!

Child Application

Child Application (in Spanish)

K5 Enrollment Referral Form

Complete form below

K5 Enrollment Referral Form

"*" indicates required fields

MM slash DD slash YYYY
Instructions: Identify student concern(s) by placing an X in the appropriate box.*
Language/literacy*
Based on Fountas and Pinnell levels
Math skills*
Emotional and Social assessment (Check all areas that child needs support)*
This field is for validation purposes and should be left unchanged.

1st Grade Enrollment Referral Form

Complete form below

1st Grade Enrollment Referral Form

"*" indicates required fields

MM slash DD slash YYYY
Instructions: Identify student concern(s) by placing an X in the appropriate box.*
Language/literacy - 40% or less*
Based on Fountas and Pinnell levels
Math skills – 40% or less*
Emotional and Social assessment (Check all areas that child needs support)*
This field is for validation purposes and should be left unchanged.

Get in Touch with YouthBase

"*" indicates required fields

Name*
This field is for validation purposes and should be left unchanged.