Pre-Assessment Application
We ask these questions so we can understand what you need and determine ahead of time whether Split Rock is the right program for you, with the right supports in place.
This Pre-Assessment is not about judging or deciding your future. It helps us prepare and make sure we approach your care in the safest and most supportive way possible.
Our goal is to welcome as many youth as we can. If we are not the right fit at this moment, we will help connect you with other services that may better support you.
You are not alone - we are here to walk alongside you.
You may either complete the form below, or download a PDF version here to fill out and submit via email or drop it off to us.
We know that not all of these questions will apply to everyone! Please answer everything to the best of your ability.
Tsë Lhts’ënc’il Nec’igekh Be Yikh (Split Rock Healing House) is committed to protecting the privacy, dignity, and confidentiality of all youth, families, caregivers, and referral partners who share information with us. Please review our full Privacy Policy before submitting your information.
Tsë Lhts’ënc’il Nec’igekh Be Yikh (Split Rock Healing House) is committed to protecting the privacy, dignity, and confidentiality of all youth, families, caregivers, and referral partners who share information with us. Please review our full
Privacy Policy before submitting your information.