If a student is in danger right now, do not use this form
This form is read during office hours only. It is not monitored around the clock, and submitting it does not alert anyone immediately.
Call 911 for immediate danger · 988 for the Suicide & Crisis Lifeline, 24 hours · 211 for 24-hour crisis counseling in English, Spanish and Creole · 1-800-962-2873 for the Florida Abuse Hotline
School Resource Referral Form
This form connects a student and their family to free services from A New Life in Christ Ministries and Resources, a faith-based 501(c)(3) nonprofit serving Miami-Dade and Broward Counties since 1984. It is completed by school staff, not by families.
You can refer up to seven students in one submission. Leave the extra student blocks blank if you are referring fewer.
Are you a parent or family member? This is not the right form. Request an appointment here instead, or call (786) 396-3144.
| Who completes this form | School counselors, social workers, teachers, administrators and other school personnel |
|---|---|
| Students per submission | Up to seven |
| Cost to the family | Free. A New Life in Christ Ministries and Resources never charges families. |
| Cost to the school | Free |
| Counties served | Miami-Dade and Broward, Florida |
| Time to complete | About 5 minutes for one student |
| What you need | Student name, date of birth, grade and school; parent or guardian name, address, phone and email; your own name, phone and email |
| Response | Staff contact the family directly, then confirm back to you |
| Questions before you submit | (786) 396-3144 |
Who is this form for?
School personnel in Miami-Dade County and Broward County who have identified a student whose family needs support. That includes counselors, social workers, teachers, attendance staff, McKinney-Vento liaisons and administrators.
A New Life in Christ Ministries and Resources works with Miami-Dade County Public Schools Title I schools, Project UP-START, and the Broward County Public Schools HEART program.
What happens after I submit?
Staff at A New Life in Christ Ministries and Resources contact the parent or guardian directly using the details you provide. They screen the whole household rather than the single presenting need, complete any benefit applications the family qualifies for, and refer the family to partner organizations for anything outside their scope. You are then told the family has been served.
Do I need parent permission first?
Yes. This form asks for the student's name, date of birth, and parent contact details. Under FERPA, sharing personally identifiable information from a student's education record with an outside organization generally requires written parental consent. Follow your district's process before submitting.
If you do not yet have consent, you can still call (786) 396-3144 to discuss the situation without naming the student.
What services can I request?
The checklist further down covers food assistance, help applying for benefits, health coverage, housing and shelter support, mentoring, employment help and more. Tick everything that might apply. Staff will work out what the family actually qualifies for, so you do not need to know which program fits.
Can I refer more than one student?
Yes. This form has seven student blocks. Use as many as you need for siblings in the same household, or for several students from your caseload. Leave the rest blank.
Is there any cost?
No. Every service is free to the family and free to the school. A New Life in Christ Ministries and Resources is a registered 501(c)(3) nonprofit and a MyACCESS Partner with the Florida Department of Children and Families.
Before you start
- Have parent or guardian contact details ready. The form cannot be actioned without a working phone number.
- It does not save partway through. Finish in one sitting.
- Include your own contact details. Staff confirm back to the referring school, and they need somewhere to send it.
- Only share what you are authorized to share. Follow your district's consent process first.
- Not sure this is the right route? Call (786) 396-3144 before submitting.