Referral Partner Portal

Submit a Referral

Submit one participant or up to 5 at once. For larger groups, use the CSV upload option below.

Already a Referral Partner?

If you've submitted referrals before, enter your Partner ID to auto-fill your contact information.

RP-

Contact Information

Your Contact Information

This information will be used to assign your Partner ID and send you referral updates.

First Name *

Last Name *

Work Email *

Phone *

Title / Role *

Organization or Department Name *

Your Role or Organization Type *

Participant Information

You can add up to 5 participants on this form. For more than 5, use the CSV upload below.

Participant #1

First Name *

Last Name *

Date of Birth *

Phone *

Case or File Reference Number (optional)

Submitting More Than 5 Participants?

Download the CSV template below, fill in your participant information, and upload it here. We'll process all referrals and link them to your Partner ID.

I confirm that I am an authorized staff member or professional and that I have appropriate authorization to submit this referral on behalf of the participants listed above. I understand that Life Skills 101 is not a court-run program and does not constitute legal, probation, counseling, or case management services.