Form Center

Search Forms:

Search Forms Select a Category

All Categories
City Clerk
City Manager
Commission on Arts & Culture
Communications & Engagement

Community Development
Fire
General Services
Nondiscrimination and Accessibility

Parks & Recreation
Police
Recycling Division
Street Systems

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Youth Fire Intervention Referral

Sign in to Save Progress

This form has been modified since it was saved. Please review all fields before submitting.

Family Information:
Name of Parents/Guardians*
Home Address
Parent/Guardian Phone*
Parent/Guardian 2nd Phone
Parent/Guardian E-mail
Name of Youth*
Age & Grade in School*
School Name
Referral made by:
Name*
Contact Information*
Why is this youth being referred?
Provide a description of the incident for which this youth is being referred to Youth Fire Intervention.
Tell us about the fire*
What happened? What was used to start the fire? What material was set on fire? Why does the youth say the fire was set?
Approximately when did this fire happen?*
Approximately when did this fire happen?
Approximately when did this fire happen?
Did any of the following occur with the fire set by youth:*
1. fire/police department responded
2. injury to self or others occurred
3. damage to property occurred
4. multiple youth involved
5. none of these