At PCRS, we want to support and work with you. Whether you are looking for a new job, a new home, or an education, our staff are here to help.

Here are our service offerings:

EDUCATION
We provide youth with the opportunity to learn, improve, and explore their strengths and interests. We are committed to supporting young people acquire skills, confidence, and competence to be successful in their educational and employment pursuits. We believe that young people can achieve their goals and reach their full potential when they’re provided with support and resources along their educational journeys.

EMPLOYMENT
We provide employment services to job seekers and employers in various communities to help participants prepare for employment, secure and maintain jobs, and gain meaningful work experience. Employment is a key component to quality of life. We believe that every person has the capacity and potential to be successful given the right support.

HOUSING
We provide housing services that support vulnerable people who are homeless or at risk of homelessness to maintain stable, long-term housing. We serve through street outreach, housing search, and housing-first programs. We are committed to and passionate about ending homelessness in our communities. We believe that housing is a right.

SUBSTANCE USE & MENTAL HEALTH
We provide substance use and mental health services that meet participants where they’re at recognizing that participants have different relationships with substance use. With compassion and professionalism, we approach participants to help them see who they truly are outside of their addiction. We believe in striving to help them to live healthy, thriving, empowered lives.

YOUTH & FAMILY SUPPORT
We provide a high-level of support to families, youths, and adults in the communities we serve. We encourage life skills, personal growth, and a sense of belonging and connection. We operate youth centres, one-on-one and group supports that engage youth through education, outreach, and case management. We believe that a sense of belonging for youth and families fosters healthy communities.

To apply for support in any of these areas please continue to the next page. The following application will ask for some basic information. After you submit this form, you can expect that someone from our team will reach out to you with next steps.

If you are interested in applying to any of the PCRS housing programs, please refer to our Housing Referral Form.

Form Type

What would you like support with?

Which region would you like to participate in our services with?

Which program are you interested in?

Other, please specify

WorkBC

For any WorkBC related services visit (do not submit a form):
https://www.workbc.ca/Employment-Services/WorkBC-Centres/Find-Your-WorkBC-Centre.aspx

This is a gated program that receives referrals from MCFD SW, CYMH Clinician, or probation officer only.

Are you a MCFD SW, CYMH Clinician, or Probation Officer?

YESNO

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Preferred Name

First Name

Middle Name

Last Name

Legal Name

First Name

Middle Name

Last Name

Participant Contact Information

Primary Phone Number

Alternate Phone Number

Email Address

Preferred Method of Contact

Emergency Contact Information

Emergency Contact Name

Relationship to Participant

Emergency Contact Phone Number

Emergency Contact Email

Basic Information

Date of Birth (MM/DD/YYYY)

Gender

Pronoun(s)

Ethnicity

If Indigenous, please specify

Other, Ethnicity

First Nations Band (if applicable)

Social Insurance Number

Personal Health Number (PHN)

Citizenship Status

Permanent Residence number

Language Support needed?

What language do you need support with?

Family Information

Marital Status

Type of Care

Participant Family History

Marital Status, other

Number of Dependents

Child/Sibling Information

Child 1: Name

Child 1: Date of Birth

Child 1: Indigenous

Child 2: Name

Child 2: Date of Birth

Child 2: Indigenous

Child 3: Name

Child 3: Date of Birth

Child 3: Indigenous

Child 4: Name

Child 4: Date of Birth

Child 4: Indigenous

Children's Diagnosis (list)

Please list name, age, gender of dependents and if they are indigenous

Home Address

Street 1

Street 2

City

Province

Postal Code

Alternate Address

Street 1

Street 2

City

Province

Postal Code

Current Medications/Prescribed for (if applicable)

Substance Use History

What substances are causing you problems?

Frequency of Use?

Amount Used

Date Last Used (MM/DD/YYYY)

Referral Date

Status

Referral Information

Source of Referral

Reason For Referral

Sexual Exploitation/Gang Concerns

Referrer Contact Information

Referrer Name

Referrer Agency

Referrer Address

Referrer Phone

Referrer Email

Relationship to Participant

Is this referrer the participant's primary professional support

YESNO

Office Code

Urgent Needs

Urgent Services Required?

YES

Urgent Needs Explanation

Areas of Concern

Ongoing Needs/Concern?

YES

Areas of Concern Explanation

Criminal Justice Involvement (if applicable)

NonePastCurrent

Youth Justice Participant Information

Correction Service Number

YCNRA Needs (If applicable)

YCNRA Risks (If applicable)

Social Worker (if applicable)

Name	Agency
Phone Number	Email
Type

Transition Worker (if applicable)

Name	Agency
Phone Number	Email
Type

Probation Officer (if applicable)

Name	Agency
Phone Number	Email
Type

Other Professional Contacts

Name	Agency
Phone Number	Email
Type	Specify relationship

Legal Guardian (if applicable)

Name	Phone Number
Agency	Type
Email

Caregiver

Name Phone Number	Specify relationship Type
Email

Participant Goals

*Please do not exceed the 255 word limit when typing in goals.*

Goal 1

Goal 2

Goal 3

Goal 4

Club Utopia: Eligibility Questions

Do you Identify as Female?

Do you identify as South Asian?

Are you Between 12-18 Years Old?

Do you Currently Reside in Surrey?

Comments (if applicable)