Referral for Residential Services

Contact Information for Youth Residential Application

Inquiries and referrals may be made to the Director of Intake. An application and collateral information will be reviewed. A pre-placement interview may be conducted with the youth and family. A youth’s placement at an LSS residential program is based on the program’s ability to help the youth and family meet their needs.

For inquiries or to make a referral please contact:

Bryan C. Harberts, Director of Intake
LSS Residential Services for Children & Youth
605-221-2421
Bryan.Harberts@LssSD.org

LSS Residential Center Referral Form

The referral provides information to determine if a child meets the criteria for care. Please submit a completed referral form below. An LSS representative will contact you as soon as possible to continue the application process.

Please Complete the Following Information to Refer a Child to an LSS Residential Center.

Client Information:

Age (Required)

Gender

male
female

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Desired Placement Date (Required)

Please send referral to appropriate center(s).

Canyon Hills, Spearfish
Summit Oaks, Sioux Falls

Referred By:

Your Name (Required)

Organization (Required)

Relationship To The Child (Required)

Country

Address Line 1 *

Address Line 2 *

City *

State/Province *

Postal Code *

Phone Number (Required)

Fax Number

Email Address (Required)

Questions

Comments

Preferred Response

Email
Phone
Mail