Referral for Pregnant or Parenting Youth Program

Teen Success, Inc. is a program for pregnant or parenting young mothers who still need to graduate high school or get a GED.

Use the form below to refer a young woman who could benefit from this program and we'll be in touch with you within one business day. Thank you!
Prefer to print and fax in your referral? Download the form here and fax it to (408)516-9671.

    Participant Referral Form

    Prospective Participant Information:
    Teen Success, Inc. has programs in the following California cities: Fresno, Greenfield, Sacramento, Salinas, and San Jose 
    Where does the prospective member live? 
    Referrer Information
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Redwood City program members visiting Evernote
Anything is possible when we have genuine support and believe in ourselves." 
- Alba Stephanie, Teen Success, Inc. Graduate
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Visalia member, Angelica, and her son, Mateo
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San Jose graduate, Isabel, and her son, Elias