School Program Referrals

Please complete ONLY as a TLDSB referral, on behalf of a student. Please ensure parent/guardian consent prior to completing as we will need to contact parent/guardian throughout program. This form is designed for In-School Mentoring (ISM) or GO GIRLS! group programming. Programs will start in January. ISM will run from January until April/May, for matches to meet 1 hour/week virtually. GO GIRLS! will run for 6 to 8 weeks, depending on arranged schedule, beginning in January. Dates to be confirmed. GO GIRLS! is designed for girls in grades 6 to 8.
  • SCHOOL REFERRAL INFO

  • PARENT/GUARDIAN INFORMATION

  • STUDENT INFORMATION

  • (eg. ADHD, Asthma, Autism Spectrum Disorder, Fetal Alcohol Spectrum Disorder, Learning Disabilities, ODD, etc.)
  • AVAILABILITY

    Both programs will begin in January 2021.
  • PROGRAM REQUIREMENTS

    Both ISM and GO GIRLS will be run virtually using programs such as Zoom, Google Meets, etc.. These programs are video applications that can be used on smart phones, tablets, and computers. The virtual link will be secure and private. More information will be provided once group spot is confirmed.