REFERRAL FORM

If you know a family or child who may benefit from our services, please inform the family you are referring them and complete the form below.

Parent/Guardian Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone #(Required)

Alternate Phone #(Required)

Child(ren)'s Name(Required)

First Last

Child(ren)'s School(Required)

Child(ren)'s Age(Required)

Please enter a number from 0 to 25.

Reason for Referral(Required)

Who is making the referral?(Required)

Referring Agency

Individual Making a Referral

If a Referring Agency, please list name

Referring Individual's Name(Required)

First Last

Referring Agency Phone(Required)

Referring Agency Email(Required)

Enter Email Confirm Email

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The Martinsburg Initiative (TMI) is a police, school, health, community, and education partnership that supports families of children in the Martinsburg community who may have been exposed to toxic stress. TMI provides wraparound support for families by assessing challenges and strengths and addressing them to build strong families and healthy children.

THE MARTINSBURG POLICE DEPARTMENT

The department partners with TMI by regularly visiting classrooms in our eleven target schools to foster positive relationships with students.

The department also incorporates trauma-informed policy by practicing Handle With Care, a program designed to alert the school system when a child has experienced a possible traumatic event. In addition, the MPD provides a Jr. Police Academy for rising 5th, 6th, and 7th graders.