Forms

Welcome Message for Families
Start Here: Youth Intake Packet – For-Profit Services
Welcome to Unbreakable Youth Center. We’re honored you’re considering our trauma-informed, youth-centered services. This intake packet is your first step toward joining a movement built on empowerment, creativity, and resilience.
All services offered through this portal are fee-based, with limited sliding scale and scholarship options available. We believe every youth deserves to be seen, heard, and supported—and we’re here to make that happen.
Please follow the instructions below to begin.

How to Complete & Submit Your Intake Forms
Welcome to Unbreakable Youth Center’s for-profit services. To begin the intake process, please follow the steps below:
📝 Step-by-Step Instructions
1. Download Each Form Below
Click the buttons to download each form individually. These are standard PDFs that can be printed and filled out by hand.
2. Complete All Required Sections
Be sure to fill out each form completely. Incomplete forms may delay your intake process.
3. Scan or Photograph Your Completed Forms
Once filled out, you may scan the forms or take clear photos of each page using your phone.
4. Email Your Forms to Us
Send your completed forms to:
📧dr.coleman@unbreakable-youth-center.org
Please include your youth’s name in the subject line:
Subject: Intake Forms – [Youth’s Full Name]
5. We’ll Follow Up Within 2 Business Days
Our team will review your submission and contact you to confirm services, schedule your first session, or discuss next steps.

🔐 Privacy Notice
All submitted information is kept confidential and used only for service enrollment. If you have questions before submitting, feel free to email us at the address above.