Areas We Serve:

Who Can Make a Referral?

Anyone that knows a youth can make a referral. Ascent frequently receives referrals from parents, relatives, schools, teachers, counselors, mental health professionals, probation officers.

how do i make a referral?

You may submit a referral by filling out a referral form below and by clicking  "submit." For a printable version, click here.  If you have questions, please contact us or call 318-654-4245.

next steps

After you have submitted a referral form, you will be contacted by our Intake Coordinator.

Submit the following form to refer a youth to Ascent Monroe.

For more information, questions, or to speak with an Ascent Representative, e-mail Caitlin Milam at or call 318.654.4245.

Date *
Youth's Name *
Youth's Name
Date of Birth
Date of Birth
(This information is not necessary at this time but could speed up the referral process)
Legal Guardian Phone 1 *
Legal Guardian Phone 1
Legal Guardian Phone 2
Legal Guardian Phone 2
If applicable