Intake Form

Welcome to the Da’luk Youth Program! The Da’luk Tribal Youth Program aims to promote healing through culturally-rooted lessons, to develop social/emotional competency, and to support training and development of youth advocates on policy, systems, and environmental change to prevent substance use, while promoting positive cultural identity and tribal wellness among middle and high school Native American students in Humboldt and Del Norte County. The purpose of the Da’luk Youth Program is to provide Native American youth, ages 12–18, the tools and skills they need to make positive contributions to their communities. In collaboration with traditional cultural bearers, the Da’luk Youth Program will cultivate healthy life outcomes for Native youth to flourish into future leaders.

Both the Youth Applicant and their Parent or Guardian will need to fill out and sign sections of this form. You need to complete the entire form or it will not be sent to Da'luk staff. After your application has been submitted, you will receive a confirmation email and Da’luk Youth Program staff will follow-up with you once they have reviewed your information.

If you need assistance filling out the form, have questions about this form, or would like a paper copy sent to you, please contact:

Vincent Feliz, Da’luk Youth Program Coordinator at 707-276-6336, vincentf@ncidc.org or
Karen Asbury, Program Assistant at karen@ncidc.org

Our program could not be possible without the generous support of The Center at Sierra Health Foundation and Elevate Youth California.