Endaayaang Referral Form

Please return all Endaayaang intake forms to scameron@hric.ca or fax by (905) 545 – 4077. Housing First for Youth referral criteria:

Eligibility Requirements

  • Young adults ages 16-24
  • Exiting child welfare, justice system, healthcare discharge, or fleeing unsafe environment
  • Priority will be given to Indigenous young adult

    Client Information

    Do you self identify:


    Emergency Contact Information

    Can we contact this person if we need to reach you?

    Current/Past involvement with the CAS/CCAS:

    Current/Past involvement with the Justice System:

    Current/Past involvement with the Health Care System: 

    Is there or has there been a safety concern: 


    Referral Source Information


    Endaayaang Staff Only