interested in being connected to a caring adult? The LIFEGUIDES mentoring program is aimed at building life skills and community connections for foster youth ages 17-23 years old. You will be matched with a volunteer LIFEGUIDE based on interests and preferences. You will meet weekly at an agreed upon location for the 12 week program. Name* First Last Independent Living Specialist or Case Manager InformationIndependent Living Specialist or Case Manager Name* First Last Independent Living Specialist or Case Manager Email* Independent Living Specialist or Case Manager Phone*Placement*Foster HomeGroup HomeAge 18+RelativeNon-RelativeOtherIf other, please explain.*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Do you have any children?*YesNoEmail* Date of Birth* Your Gender*FemaleMaleYour Ethnicity*African-AmericanAsian-AmericanCaucasianHispanic-LatinoMulti-EthnicOtherIf other, please specify.*Current Job (if working):Are you currently attending school?*YesNoIf yes, which school and what area of study?*Grade in School*9101112GEDCertificationCollegeOtherIf other, please specify.*Are you currently enrolled in on of the following programs?*PESSExtended Foster Care (EFC)RTIOpted out of careOtherIf other, please explain.*Are you interested in joining the Military?*YesNoIf yes, what branch of the Military are you interested in?*What are your career goals?*Do you volunteer or do charity work? If yes, where at?*What computer skills do you have (please check all that apply)?* Microsoft Word Excel Powerpoint Photoshop Access Garage Band or other recording program Web design Other None If other, what computer skills?What computer skills would you like to learn?*What is the best time to meet with your LIFEGUIDE (please check all that apply)?* Weekday Mornings Weekday Afternoons Weekday Evenings Weekend Mornings Weekend Afternoons Weekend Evenings Most of the time, I feel...* thankful excluded strong happy included weak capable sad confident dumb proud unstable frustrated smart normal excited talented different content angry special respected prepared financially calm valuable hopeful anxious/worried worthless depressed prepared afraid out of control resourceful supported To help us match you with a LIFEGUIDE, we'd like to get to know you.What are your interests?*What is your favorite food?*What is your favorite place to eat?*What is your favorite travel destination and why?*Favorite TV show?*Favorite movie?*Favorite thing to do in your free time?*Favorite book/magazine?*What other languages do you speak?*Have you played sports?*YesNoIf yes, what sport(s)?*Have you played a musical instrument?*YesNoIf yes, what instrument(s)?*Please describe your personality (check all that apply):* quiet talkative outgoing moody cheerful nervous shy friendly analytical visionary artistic nurturing adventurous reserved other If other, please describe:*What personal qualities would you like in a LIFEGUIDE?*What is your primary mode of transportation?*BusCarRide with a friend/relative/otherWhy do you want a LIFEGUIDE?*When working with a LIFEGUIDE, do you have a preference to any of the following? Please keep in mind that we will do our best to match you with a LIFEGUIDE who meets your preferences, but we cannot guarantee an exact match.Gender*It doesn't matterYesIf yes, which gender?*FemaleMaleReligion*It doesn't matterYesIf yes, which religion?*Ethnicity*It doesn't matterYesIf yes, which ethnicity?*African-AmericanAsian-AmericanCaucasianHispanci/LatinoMulti-racialOtherIf other, which ethnicity?*Are there any other preferences you have for a LIFEGUIDE?*EmailThis field is for validation purposes and should be left unchanged.