Coaching Referral for Foster Youth

Career Coaching for Foster Youth

Use this form to apply for one-on-one career coaching for foster youth. Approval is required and is based on eligibility and available funding.

"*" indicates required fields

Name of Person Completing This Form*

First Last

Coaching Requests require a consent to be submitted by the legal guardian or the consent of an adult participant over 18 years old. This consent can be submitted subsequent to this request.

Email*

Phone*

Relationship to Youth*

Self (student 18+)

Social Worker / Legal Guardian

Other (Foster Parent, TFC Worker, Relatives)

Explain your relationship to the youth

Social Worker / Guardian Name*

First Last

Social Worker / Guardian Email*

Coaching Guidelines

• A Responsible Adult must be present for all coaching sessions and is responsible for providing a suitable work environment, as well as materials and supplies. • Cancellation or rescheduling of a session requires 24-hour notice to the coach, otherwise the session is reported as a No Show to the Social Worker. • Upon return home or adoption, enrolled students remain eligible for coaching through the end of the academic year and one additional academic year. • Following each Coaching Session, a Session Report is completed by the coach and TFFC provides this report to the Social Worker and a session summary to the caregiver.

Acknowledgements:*

One-on-one coaching in the student’s home will begin approximately 2 weeks from referral submission (except for youth just entering care, which takes approximately 4 weeks).

I have notified the parent/caregiver that the Youth has been referred for coaching services through TFFC and discussed scheduling availability.

Upon three (3) No Shows, TFFC will suspend coaching services and the Social Worker will be asked to call a Family Team Meeting to address attendance issues before services can be resumed.

Please read and acknowledge by clicking the boxes.

Coaching Guidelines for Students over 18

• As an Adult, you are responsible for providing a suitable work environment for coaching sessions. • Cancellation or rescheduling of tutoring sessions requires 24-hour notice to the coach, otherwise the session is reported as a No Show to the Social Worker. • Following each Caoching Session, a Session Report is completed by the coach and TFFC provides this report to the Social Worker by email.

Acknowledgements:*

One-on-one coaching in the youth’s home will begin approximately 2 weeks from referral submission (except for youth just entering care, which takes approximately 4 weeks).

Upon three (3) No Shows, TFFC will suspend coaching services and the Social Worker will be asked to call a Team Meeting to address attendance issues before services can be resumed.

Please read and acknowledge by clicking the boxes.

Student Information

We will collect the remaining information from the Caregiver/Guardian once you have submitted the form.

Youth's Name*

First Last

Youth's Date of Birth*

Youth's Current Age*

Please enter a number greater than or equal to 0.

Are you who we should Contact to Coordinate Coaching Sessions?*

Yes

Who should we contact to coordinate coaching sessions? (POC)*

First Last

Phone for POC*

Email of POC*

Student's Home Address OR Location of Coaching*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

School*

Grade Level*

TFFC values our clients' academic success! Students in 9th grade and above in the coaching program will automatically be offered free tutoring support within the academic year. If they do not need nor wish to participate in this support, they can simply decline when we reach out.

Does your youth have access to a computer?*

Yes

During Career Coaching TFFC may have the youth fill out online career questionnaires to gauge areas of interest and aptitude. Please let us know if your youth has access to a computer at home or requires one.

Does your youth require supervision for the use of electronics?*

Yes

During the course of your youth's coaching they will be taking online assessments. Please let us know if they are not otherwise allowed to use electronic devices and will require the direct supervision of their tutor or parent/caretaker while taking these assessments.

Days/Times Available for Coaching*

Share any information that would pertinent to Career Coaching

Describe any Special Requests for Coaching

Emotional Stability*

I confirm student is physically and emotionally stable enough for weekly coaching services.

Ready for Coaching?*

I confirm that I am physically and emotionally prepared for weekly coaching services.

Does your youth need Academic Tutoring?

Opt in to Academic Tutoring

Let us know if your student would benefit from one-on-one, in-home academic tutoring services.

CONSENT TO EXCHANGE INFORMATION ON YOUTH

As the Legal Guardian, I understand that The Friends of Foster Care, Inc. (TFFC) provides services and benefits to youth in my guardianship. TFFC must have specific information to provide services and benefits. By signing this form, I am allowing TFFC to exchange certain information so it will be easier for them to provide or coordinate these services or benefits.

Legal Guardian's Name*

First Last

Legal Guardian's Agency*

If no Agency, please put N/A.

Legal Guardian's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

I want the following confidential information about the youth to be exchanged with The Friends of Foster Care, Inc. - 999 Waterside Dr., Suite 103, Norfolk, VA. 23510 Phone: 757-227-4187 Fax: 757-561-0979 Email: tutoring@friendsoffostercare.org*

Grades, Progress Reports and Report Cards

Assessment Information

This information will be exchanged ONLY for the purpose of Service Coordination for the TFFC Career Coaching Program.

Period of Consent*

I can withdraw this consent at any time by notifying The Friends of Foster Care. This will stop all Schools/Agencies from sharing information after they know my consent has been withdrawn. I have the right to know what information about has been shared, and why, when, and with whom it was shared. If I ask, The Friends of Foster Care will show me this information.

Electronic Signature*

By selecting CONSENT box and Typing my Full Name above, I confirm my consent and understand that I am electronically signing this form.

Today's Date*

Consent to Exchange Information for Students 18+

I understand that The Friends of Foster Care, Inc. (TFFC) provides educational services and benefits and that TFFC must have specific educational information to provide such services. By signing this form, I am allowing TFFC to exchange certain information with my school so it will be easier for them to provide or coordinate these services or benefits.

I want the following confidential information to be exchanged with The Friends of Foster Care, Inc. - 999 Waterside Dr., Suite 103, Norfolk, VA. 23510 Phone: 757-227-4187 Fax: 757-561-0979 Email: tutoring@friendsoffostercare.org*

Grades, Progress Reports and Report Cards

Assessment Information

This information will be exchanged ONLY for the purpose of Service Coordination for the TFFC Career Coaching Program.

Period of Consent*

Electronic Signature*

By selecting CONSENT box and Typing my Full Name above, I confirm my consent and understand that I am electronically signing this form.

Today's Date*

CAPTCHA

This field is for validation purposes and should be left unchanged.

Make Another Referral

Coaching Referral for Foster Youth

Career Coaching for Foster Youth

Coaching Guidelines

Coaching Guidelines for Students over 18

Student Information

CONSENT TO EXCHANGE INFORMATION ON YOUTH

Consent to Exchange Information for Students 18+

Volunteer with Us!

Interested in foster parenting?