Admissions Form

If you would like to make a referral to Virginia Home for Boys and Girls, please complete the online admissions form. Your request will be reviewed and you will receive a response regarding the appropriateness for placement within 24 hours or by the next business day.

The application may be completed online or faxed in with the other supporting documents to (804) 934-9013. Upon receipt of the completed Admissions Application and supplemental documents, you will be contacted to confirm their arrival.

If the applicant meets our admissions criteria, a pre-placement interview will be scheduled either on our campus or at the child’s current placement.

Following the interview, a decision for placement will be made within 24 hours or the next business day and you will be notified at this time. If your referral is accepted, an admission date will be scheduled at that time.

We will need these additional documents before the placement is finalized:

  • Copy of Insurance Card
  • Immunization Record
  • Copy of Birth Certificate
  • Copy of Social Security Card
  • Most recent school transcript
  • Current IEP
  • Educational Records
  • Physical Examination (date of last visit, Dr. name & phone #)
  • Dental Examination (date of last visit, Dr. name & phone #)
  • Copy of custody order
  • Placement agreement signed by funding agency, placing agency and guardian

Please note that we do accept Emergency Placements. These placements will be reviewed and addressed on a case-by-case basis.

I certify that I have the authority to complete the application on behalf of this youth and that all information furnished is complete and accurate to the best of my knowledge: