Please click and download the appropriate referral forms below and fax them to the associated fax numbers.


To submit your Kinship Support Services referral form, please fax it to (510) 232-3460.

Youth Service Bureau Kinship Support Services Referral Form


To submit your Wraparound Services referral form, please fax it to (510) 231-7810. Your child must have Full Scope Medi-Cal to be eligible.

Youth Service Bureau Wraparound Services Referral Form


If you have any questions about the application and referral process, please do not hesitate to contact your nearest WCCYSB office. We are here to serve you and your family and to ensure that your loved one’s process of community-focused rehabilitation is receiving the utmost care and support.