Refer Your Students Online

School Administrators should use this form to refer student(s) who have consented to being contacted by Kick It California. Kick It California will call the student as soon as possible to enroll them in the program and to talk with a Quit Coach.

School Administrator Information

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Student Information

Student consents to:

Allow the referring organization to share contact information with Kick It California (KICA) for the purpose of offering services (contact by phone, text, or email).


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Kick It California (formerly California Smokers' Helpline) offers free services to help California students (ages 13 or older) quit vaping, smoking or using other tobacco. Services are offered in English, Spanish, Mandarin, Cantonese, Korean, and Vietnamese.

Kick It California complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Major funding provided by the California Department of Public Health & First 5 California.Copyright © 2021. The Regents of the University of California. All Rights Reserved.
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Major funding provided by the California Department of Public Health & First 5 California.
Copyright © 2021. The Regents of the University of California. All Rights Reserved.