YWC Mobile Team Referral Form YWC Mobile Team Referral Form The Youth Wellness Centre Mobile Team will offer mental health and substance use support to students aged 17-25 at Redeemer University College. The team can offer mental health support, transition support, peer mentoring, education and substance use counselling. Please complete the referral form and return to: the YWC mailbox in the administration area (in a sealed envelope). Referrals will be collected and triaged weekly. Student Name* First Last Phone Number*Can we contact by email?*YesNoEmail Date of Birth* Age*Name of Referrer* First Last Reason for Referral:*(Primary area of concern, diagnosis, etc.)What services would the student need?(Peer support, substance use counselling, family support, etc.)Which team members do you recommend?* RN Care Coordinator Peer Support Substance Use Counsellor Clinical Therapist Support and Family Worker NameThis field is for validation purposes and should be left unchanged.