Thank you for your interest in our programs. Please see the criteria section under the form itself for more information. You can also download the General Parent Information Package 2018 to review more detailed information. (If you are not the parent/guardian but have questions about the process please visit this page for information and contact information:

Please note that this is NOT an application form. This form is to request an intake PRIOR to being requested to fill out an application form.

  • Parent/Guardian Information


  • (first and last)

CRITERIA (Please click to expand this section)


Girls may enter the program at 6, boys 7, and non-binary youth at 9. Youth must voluntarily want to be a part of the program, and will be updated regularly while they are waiting for a match. Youth will be offered group and short-term programs immediately after acceptance.

Youth who are under 16 years of age must have a parent/guardian who supports the application and can be involved in the process. Youth who are over 16 will be assessed as the primary applicant, should they wish to advocate for themselves. If you are not the individual with legal signing rights for the child, the legal signatory must provide permission.

Youth, and parent/guardians if applicable, must agree to regular contact with the Agency.

Youth must reside in Winnipeg

As there are many programs and many considerations when determining program eligibility and fit, there may be criteria not listed here that is program specific.

An Enrollment Coordinator will work with you and your child to review your situation and determine how a mentor would be of benefit. Factors that would be considered regarding your child’s needs include:

  • Parent or guardian support
  • Adult involvement other than the parent(s) or guardian(s)
  • Peer relationships
  • School performance
  • Involvement in community activity
  • Living environment
  • Mental health needs
  • Ability to form and maintain a healthy, safe relationship
  • Ability to perform self-care