YES - Self-Referral Resource Request

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Referral for exploring resources available to aged-out youth and young adults post foster care

Email *

Are you a former CASA youth with CASA of Baltimore County? *

Yes

Maybe

Your Name, E-mail address & Contact Phone *

Your Date of Birth *

Your Gender Identity (we use this information without names attached for grant purposes and identifying appropriate resources - we will not give this information away) *

Female

Male

Non-binary

Other

Choose not to respond

Your Ethnicity (we use this information without names attached for grant purposes and identifying appropriate resources - we will not give this information away)

Black

White

Hispanic

Asian

Bi-racial

Choose not to respond

Other:

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Types of Resources requested *

Job Resources (part-time, retail, etc.)

Career Resources and Training and Internships

Educational Support (GED, tutoring, college)

Pregnancy/Parenting

Mental Health/Wellness

Housing Resources

Emergency Housing Resources (immediate needs)

LGBTQ+ support

Other:

Required

What concerns/issues are you experiencing that that have led you to request this consultation? *

Anything else we should know about you? Tell us anything that will help us help you! *

How would you like to be communicated with regarding the requested resources?
*

I would like the resources to be e-mailed or texted to me!

I would like to set up a phone call to discuss the resources and my needs

I would like to schedule a meeting (in-person/virtual) with the Youth Engagement Specialist

A copy of your responses will be emailed to the address you provided.

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