Recommend a Student We accept recommendations for students in grades 3-11 at the schools listed in the drop-down form below. YMI Mentee Recommendation We've detected that Javascript is not enabled. It is required for an optimal survey taking experience. Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript. Skip survey header YMI Mentee Recommendation Student Referral Information Student's First Name *This question is required. Student's Last Name *This question is required. Student's Gender/ Identifies As: *This question is required. -- Please Select --MaleFemaleTransgender FemaleTransgender MaleNon-BinarySelf DefinesPrefer not to Disclose Pronouns Student's Grade for the current school year -- Please Select --3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade Student's School for the current school year *This question is required. -- Please Select --Brooks School Elementary (BSE)Cumberland Road Elementary (CRES)Deer Creek Elementary (DCE)Fall Creek Elementary (FCE)Fall Creek Intermediate School (FCI)Fall Creek Junior High School (FCJH)Fishers High School (FHS)Fishers Junior High School (FJH)Hamilton Southeastern Intermediate Junior High School (HIJH)Hamilton Southeastern High School (HSE)Harrison Parkway Elementary (HPE)Hoosier Road Elementary (HRE)New Britton Elementary (NBE)Riverside Intermediate School (RSI)Riverside Junior High School (RSJH)Sand Creek Elementary (SCE)Sand Creek Intermediate School (SCI)Southeastern Elementary (SES) Form Completed By: *This question is required. -- Please Select --Student (self selected)Legal GuardianYMI Campus CoordinatorSchool AdministratorTeacherSchool-based TherapistSchool CounselorSocial WorkerOther If you said other, please specify. *This question is required. Full (first and last) name of person completing this form: *This question is required. Relationship to Student *This question is required. Email Address *This question is required. This question requires a valid email address. Phone Number *This question is required. Before submitting this recommendation, YMI requests that an introduction to the program and a notice of referral be presented to both the student and student’s guardian. Completed Has the student experienced any of the following: (data used for internal funding and reporting metrics only) *This question is required. Abuse or neglect Financial hardship Imprisonment Loss of a parent due to separation, divorce, or death Mental illness – self Mental illness – family Self-harm Substance abuse – self Substance abuse – family Suicidal ideation None of the above Why are you choosing YMI for this student? (check all that apply) *This question is required. Communication skills Managing emotions Managing stress Motivation Peer relationships Self-confidence Working through hard situations / problem solving The student could benefit the most from help with:Select One Working through hard situations Seeking growth opportunities Social engagement Awareness of others points of view Controlling emotions Please provide additional information you feel would be helpful in matching this student. *This question is required.
