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Below is our online ESS Youth Referral Form for Teen Intervention Program (TIP) classes. Please fill out the form below OR click on the below link to download a printable form.

For any questions or further information, please contact an ESS TIP Staff Member directly at: 316.269.4160

  • DOWNLOAD this form, print, fill out and either:

    Mail to:
    PO Box 670
    Wichita, KS 67201

    Fax: 316.269.3550

    Bring in:
    1010 N. Main
    Wichita, KS 67203

Online ESS Youth Referral Form
Referral To (program)
***These programs do not serve youth with known gang affiliation.
Youth resides with
Risk Level
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