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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

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:
Please send referral to appropriate center(s).
Referred By:
Address Line 1 *
Address Line 2 *
City *
State/Province *
Postal Code *

Preferred Response