Life Support - Youth Referral Form
Mentoring Youth in Foster Care, Ages 11-21

Many youth in foster care want a caring adult to walk beside them during the trials and uncertainty of life in care. Our mentors commit to seeing their ‘mentee’ twice each month and staying involved as long as the youth remains in care, and beyond. Referrals can come from any child advocate, but must be approved by social services before services begin.

Your Name *
Your answer
Your Email *
Your answer
Youth Referral Information
Youth First Name *
Your answer
Youth Last Name *
Your answer
Youth Date of Birth *
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Youth Race *
Your answer
Youth Grade *
Your answer
What are the youth's interests? What does he/she like to do? *
Your answer
What are some of the youth's personality traits? How would you describe him/her to a stranger? *
Your answer
Is there any family involvement? If so, who and how often? Does the youth see siblings? *
Your answer
Does the youth have any prior charges or major concerns that a mentor should be aware of? *
Your answer
Is there anything else you would like to share to help us make a match (detail is good)?
Your answer
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