Internal City Use Only: Youth & Family Resource Coordinator Referral Form

  • Date Format: MM slash DD slash YYYY
  • Name & title of person making referral * Required
  • Name of student / family being referred: * Required
  • Address of student/family being referred: * Required
  • Mandatory reporting completed? * Required

When you click submit above the information in this form will be emailed directly to:


Jonelle Carroll

Youth & Family Community Resource Coordinator

City of Kettering/Kettering City Schools

Room 111A

3750 Far Hills Ave. | Kettering, OH 45429-2699

[email protected]

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