Rise Up! is dedicated to inspiring, influencing, and impacting kids to one day attain post high school training and education degrees through our mentoring, small groups and after school programs.

Refer a Child

If you know of a child who is age 5 to 18 with an incarcerated caregiver in the Tri-Cities area, please fill out the child referral form to refer them to our program to receive a mentor. Children of Promise also serves under-resourced kids who are in grades 4th-8th and enrolled at Mountain View Elementary, Northside Elementary, Fairmont Elementary or Indian Trail Middle School. Please fill out the child referral form to refer them to the program to receive a mentor. Children of Promise has a child waiting list and children are matched based on wait-list priority.

Child's Name: (Required)

Child's Age: (Required)

Child's Grade:

Child's School:

Caregiver's Name: (Required)

Caregiver's Phone: (Required)

Caregiver's E-mail if available:

Caregiver's relation to child:

Does this child have any siblings (if yes, list names and age, if known):

Does the child have an incarcerated caregiver? Yes No 

Referred by: (Required)

Your relation to child:

Your phone #: (Required)

Your e-mail: (Required)
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P.O. Box 4426 Johnson City, TN 37602 423.610.1242

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