College Fellows Referral Form
Guiding Youth in Foster Care to Success in College

Youth who age out of foster care have rocky statistics. 7% earn an associate’s degree and 3% earn a bachelor’s. While 70% want to go to college, 30% apply. Those who do attend often have limited family support and drop out.

Our Student Advocate provides the support necessary so youth coming from foster care succeed in college. We interview potential students, invite them into the college setting, and provide quality tutors.

The program is open to 11th and 12th graders, students gaining a GED, and high school graduates.

Youth Referral Information
Name of Youth *
Your answer
Youth Date of Birth
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Youth Race *
Your answer
Youth Grade *
Your answer
What are the youth’s interests and goals? What does he/she like to do and dream of doing? *
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 to be aware of? *
Your answer
Describe the youth’s academic success and struggles so far (detail is good). *
Your answer
Points of Contact for the Youth:
Caregiver's Name:
Your answer
Caregiver's Address:
Your answer
Caregiver's Phone:
Your answer
Caregiver's Email:
Your answer
Social Service County *
Social Service Foster Care Worker Name
Your answer
Social Service Foster Care Worker Email
Your answer
Social Service Foster Care Supervisor Name
Your answer
Social Service Foster Care Supervisor Email
Your answer
Social Services Adoption Worker/Supervisor (if applicable: Names & Emails)
Your answer
Guardian ad Litem or CASA (Name & Email)
Your answer
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