Life Support - Youth Referral Form for SC

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Mentoring high school youth and young adults who have lived in foster care.

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

Your Name *

Your Email *

Youth Referral Information

Youth First Name *

Youth Last Name *

Youth Date of Birth *

YYYY

Youth Race *

Youth Gender *

Youth are paired with mentors of the same gender.

Youth Grade *

What are the youth's interests? What does he/she like to do? *

What are some of the youth's personality traits? How would you describe him/her to a stranger? *

Is there any family involvement? If so, who and how often? Does the youth see siblings? *

Does the youth have any prior charges or concerns that a mentor should be aware of? *

Is there anything else you would like to share to help us make a match (detail is good)?

Clear form

Never submit passwords through Google Forms.

This form was created inside of Fostering Great Ideas.

Does this form look suspicious? Report

Forms