Educate Coaching referral

Educate Coaching provides middle school youth with one-on-one support from a dedicated Educate Coach who meets with them weekly. Coaches build a consistent, supportive relationship with each youth and help them navigate school, strengthen educational habits, and develop practical educational skills. Together, they work through challenges, set goals and build the confidence they need to become more independent and successful in school and beyond.

2026 Educate Coaching

"*" indicates required fields

Step 1 of 7

14%

Submitter Information

Date*

MM slash DD slash YYYY

Submitter Name*

First Last

Submitter Email*

Relation to the Youth*

Caregiver

IL Specialist/TSS

Case Manager/Caregiver Support

GAL

Educate Coach

Educate Manager

FFC Staff

Other

Youth Information

Youth Name*

First Last

Youth Email*

Youth Phone Number*

Date of Birth*

MM slash DD slash YYYY

Age*

Is the youth a parent?*

Gender*

Female

Male

Ethnicity*

African-American

Asian-American

Caucasian

Hispanic-Latino

Multi-Ethnic

Other

Placement Type*

Foster Home

Relative

Non-Relative

Group Home

In-Home Court Ordered/Voluntary/Diversion

Other

Group Home Name*

Does the youth have a diagnosis: mental, physical, behavioral, educational, etc? If so, please provide the student's diagnosis?*

Address where youth resides:*

Street Address Address Line 2 City State ZIP Code

County of Residence*

Orange

Osceola

Seminole

Grade*

School Currently Attending*

Is the youth's case open?*

Is the youth employed or in secondary education? (for students 18+)*

Is the youth incarcerated?*

Is the youth on track to graduate HS? (if student is in HS)*

Is the youth pregnant?*

Is the youth homeless?*

Risks - Please select all past/present risk factors:*

Running away

Skipping school

Homeless/lack of stable housing

Transportation barriers

Teen parent

Juvenile justice involvement

Mental health diagnosis

Academic concerns/barriers

Substance abuse

Risky sexual behaviors

Lack of familial/peer support

Relationship violence

Physical health/medical concerns

If other, please specify*

Needs - Please select all areas you hope to have your Educate Coach assist with:*

Housing

Transportation

Education

Mental/Physical Health

Parenting

Financial Literacy

Life skills development

Social Connection

If other, please specify

Child Welfare Team

Is the youth's case managed by a state/case management agency or community organization?*

Child Welfare Agency/Case Management

Community Organization

Case Manager

Case Management Agency*

CHS

GCJFS

OHU

FPOCF

Camelot Community Care

Kids Central

One Hope United

LSF

Case Manager Name*

First Last

Child Welfare Team: Primary Contact Phone Number*

Child Welfare Team: Primary Contact Email*

County Case Managed Out of:*

Orange

Seminole

Osceola

Other

Please include the name, phone number and email of any other child welfare team members to be included in collaboration & communication.

Please attach CBHA

Max. file size: 50 MB.

Community Organization

Please specify the community organization's name*

Contact Name*

First Last

Contact Phone Number*

Contact Email*

Primary Support - Caregiver Information

Primary Support Name*

First Last

Primary Support Number*

Primary Support Email*

Educational History

Is the youth actively participating in school?*

Is this student in Exceptional Student Education (ESE)?*

Is this student in English Speakers of Other Languages (ESOL)?*

Does this student have an IEP?*

Please attach IEP

Max. file size: 50 MB.

Please attach most recent grades

Max. file size: 50 MB.

Release of Information

By signing below, I approve the release of the confidential information provided in this referral to FFC, its contracted tutoring agencies and its funding agencies, including but not limited to, all FFC affiliates.

Electronic Signature: Release of Information*

Please type first and last name

Electronic Signature: Release of Information*

By checking this box you accept this electronic signature.

Consent to Services

The Foundation for Foster Children is committed to ensuring that every student in foster care achieves educational success. Our Educate Program aims to decrease the academic achievement gap among children and youth in foster care while supporting academic progress and promotion from one grade level to the next. Consent must be provided by the caregiver, caregiver support, Independent Living (IL) Specialist, Guardian ad Litem (GAL), or their respective supervisors, as applicable. This consent will remain in effect until revoked in writing by the current authorized caregiver, legal guardian, or other individual with legal authority to provide or withdraw consent, or until the Foundation for Foster Children is notified of a change in legal custody or decision-making authority. Written notification should be submitted to info@foundationforfosterchildren.org

Consent is being given by*

Caregiver

GAL

Case Manager

N/A - I do not have permission to provide consent

Please provide the name, phone and email address of the individual with permission to provide/deny photo consent. Services won't start until we have received consent to services*

Consent to Coaching Services

Educate services include: supportive services, life skills development, training. and educational services. Consent must be provided by the caregiver, caregiver support, IL specialist, TSS, GAL or their respective supervisors before services will be initiated for youth 11-14 years of age.

I agree to meet with Educate Coach weekly, prepared to participate in meetings and coordinated activities. In addition, I agree to attend workshops & actively participate in all aspects of program delivery.*

Consent to Services Statement*

By signing below, I hereby give the Foundation for Foster Children (FFC) consent to provide Education services to the youth named herein. I understand this includes Educate Coach meetings with youth and professionals such as caregivers, school personnel and employers. I agree to share notes and records, in addition to provide consent to Educate Program to share information, as necessary, to maximize collaboration and communication; and will inform the Educate Coach of any upcoming meetings regarding the youth’s needs, including Youth Transition meetings, IEP meetings; parent-teacher conferences, etc.

Electronic Signature: Consent to Services*

Please type first and last name

Electronic Signature Consent to Services

By checking this box you accept this electronic signature.

Media/Photo Consent Form and Testimonies

Any person who attends a Foundation for Foster Children (FFC) event or participates in an FFC program grants permission to FFC to record his or her visual/audio images — including but not limited to photographs, digital images, voices, sound or video recordings, audio clips, or accompanying written descriptions — and to use his or her name and such images for any purpose, including advertisements for future programs and events.

This consent remains in effect until revoked, except that it automatically ends and a new consent form is required when : ● The child turns 18, or ● There is a change in placement for a child under 18 (a new form with the current legal guardian's signature is required).

To revoke consent at any time, the legal guardian, youth, or young adult may submit a written request to [insert contact method — e.g., email/phone/address]. Revocation applies going forward only; it does not require FFC to remove or recall images, recordings, or materials already published or distributed prior to the date the revocation request is received.

Photo and Testimony Consent*

I do give consent

I do not have permission to provide consent

Please provide the name, phone and email address of the individual with permission to provide/deny photo consent.*

Media/Photo Consent Form and Testimonies*

By signing below, I hereby give the Foundation for Foster Children (FFC) permission to use my photograph and use an approved story in FFC marketing materials including, but not limited to, the website and print materials of FFC. I understand that I will not receive compensation for the use of this likeness in any form. Expires December 31st, 2028.

Electronic Signature: Photo/Testimony Release*

By checking this box you accept this electronic signature.

Rights and Responsibilities

Rights*

1. Freedom from discrimination : You have the right to freedom from discrimination related to age, ethnicity, national origin, gender, disability, religion, sexual orientation, gender orientation, values and beliefs, marital status, etc.

2. Identity and provider credentials : You have the right to know the identities, titles, specialties and affiliations of all staff and volunteers of FFC and its contracted tutoring providers, as well as anyone else involved in your service.

3. Rules, regulations and policies and procedures : You have the right to know about FFC’s rules, regulations and policies and procedures that are pertinent to the mission or type of service which you receive.

4. Service plan : You have the right to be aware of the decisions about your service. You have the right to select when you would like to receive services and to decide when to stop services. You have the right to change your service plan at any time. You have the right to refuse to participate in any service. You may change your mind and return to services after refusing service without affecting ongoing or other FFC services you may be involved in.

5. Confidentiality : You have the right to confidentiality of all information given to or obtained per rules and regulations of the US Department of Health and Human Services, Health Resources and Services Administration, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), US Department of Justice Civil Rights Division, JTFPI, and other local, county, state and federal laws, directives, and/or guidelines.

6. Client grievance procedures : You have the right to voice complaints at any time. You have the right to receive a response and resolution to any grievance, complaint or suggestion in writing in a timely manner according to FFC’s Client Grievance Policies and Procedures.

Responsibilities*

1. Correct and complete information : You have the responsibility to provide correct and complete information to FFC about your youth’s demographics, case status, academic records, and all other information required during the client intake process. You have the responsibility to provide immediate notification of any changes to placement or case status.

2. Service plan adherence : You have the responsibility of following the agreed upon service plan. And must give adequate notice if there will be a change to the plan.

3. Voicing complaints, problems, and/or suggestions : You have the responsibility for voicing complaints, problems, and/or issues in an appropriate and timely manner via FFC’s grievance process.

Consent*

I understand and accept the terms of FFC's Rights and Responsibilities agreement

Signature*

Waiver and Release of Liability Form

In return for being allowed to participate in the Foundation for Foster Children volunteer activities and all related activities, including any activities incidental to such participation (“Volunteer Activities”), the undersigned Volunteer or Parent/Legal Guardian of Volunteer if Volunteer is under age 18 (hereafter referred to using “I”, “me”, or “my”) releases and agrees not to sue the Foundation for Foster Children or its officers, directors, employees, sub-contractors, sponsors, agents and affiliates (“the Foundation”) from all present and future claims that may be made by me, my family, estate, heirs, or assigns for property damage, personal injury, or wrongful death arising as a result of my participation in the Volunteer Activities wherever, whenever, or however the same may occur.

I understand and agree that the Foundation is not responsible for any injury or property damage arising out of the Volunteer Activities, even if caused by their ordinary negligence or otherwise.

I understand that participation in the Volunteer Activities involves certain risks, including, but not limited to, serious injury and death. I am voluntarily participating in the Volunteer Activities with knowledge of the danger involved and I agree to accept all risks of participation. I also agree to indemnify and hold harmless the Foundation for all claims arising out of my participation in the Volunteer Activities.

I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state in which the Volunteer Activities take place and agree that if any portion of this Agreement is invalid, the remainder will continue in full legal force and effect. I also acknowledge that the Foundation have not arranged and do not carry any insurance of any kind for my benefit or that of Volunteer (if Volunteer is under 18), my parents, guardians, trustees, heirs, executors, administrators, successors and assigns. I represent that, to my knowledge, I am in good health and suffer no physical impairment that would or should prevent my participation in Volunteer Activities.

I also understand that this document is a contract which grants certain rights to and eliminates the liability of the Foundation.

Parent/Legal Guardian Providing Consent*

First Last

Parent/Legal Guardian if student is Under 18*

I am the parent or legal guardian of the Volunteer. I am of legal age and am freely signing this agreement. I have read this form and understand that by signing this form, I am giving up legal rights and remedies.

Electronic Signature - Waiver and Release of Liability*

Educate Coaching referral

2026 Educate Coaching

Submitter Information

Youth Information

Child Welfare Team

Case Manager

Community Organization

Primary Support - Caregiver Information

Educational History

Release of Information

Consent to Services

Consent to Coaching Services

Media/Photo Consent Form and Testimonies

Rights and Responsibilities

Waiver and Release of Liability Form

Together we are creating meaningful connections for children in foster care