top of page
Home
Business Partners
Interest Form
More
Use tab to navigate through the menu items.
Interest Form - Wake County
Eligibility requirements apply. Select a Referral Source then answer the rest based on the young person's information. Staff will reach out to determine how they may help.
Referral Source
How did you hear about us?
Choose an option
Full name of young person needing assistance
Is the individual between the ages of 16-24?
Young person's email
If you are referring yourself or are a parent referring your child, did a community organization tell you about NextGen?
Name of your agency
1800-H Tillery Place
Raleigh, NC 27604
919-615-1919
Young person's phone number
What organization?
Email for agency point of contact
Phone for point of contact
Check all that apply to the individual
Low income AND basic skills deficient (i.e. Needs improvement in reading and writing)
Pregnant or Parenting
Did not complete high school / drop-out
Homeless
Justice-involved
Current or previous IEP
In or aged out of foster care
Has a disability
Substance Use / Recovery / At-risk
SNAP/TANF or state assistance
What services does the individual need?
HS Diploma/GED
Job Training/Apprenticeship
Employment
Education
Unsure
Submit
Your submission was successful!
bottom of page