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Frank Altomari Legacy Fund

RING ASSESSMENT

Date

MM slash DD slash YYYY

Staff completing the RING Assessment(Required)

RING Assessment Reason

Student Information

Student Name

First Last

Grant Transfer

Grant Transfer Reason(Required)

Previous Grant(Required)

New Grant(Required)

Date services started under the new grant(Required)

MM slash DD slash YYYY

New Address

Address where student resides

Street Address City State ZIP Code

Risks

Please indicate the top (3) risks in order of (highest to lowest)(Required)

Please indicate the top (3) risks in order of (highest to lowest)(Required)

Please indicate the top (3) risks in order of (highest to lowest)(Required)

Were these risks identified in the referral?(Required)

Example: “No, the referral was submitted by youth.” “Only 2/3 risks were identified in the referral”

Risks not identified in referral(Required)

Running away

Skipping school

Homeless/lack of stable housing

Unemployed/employment barriers

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

Other

Select all that apply

Please describe how risks were determined(Required)

Insights

Please describe the client’s awareness, understanding and/or perception of identified risks factors(Required)

Needs

Please indicate the top (3) needs in order of highest to lowest(Required)

Please indicate the top (3) needs in order of highest to lowest(Required)

Please indicate the top (3) needs in order of highest to lowest(Required)

Were these needs identified in the referral?(Required)

Example: “No, the referral was not submitted by youth.” “Only 2/3 needs were identified in the referral”

Needs not identified in referral(Required)

Housing

Transportation

Employment

Education

Mental/Physical Health

Parenting

Financial Literacy

Life skills development

Please describe how needs were determined(Required)

Goals

What is the primary goal for this client?(Required)

Please indicate additional goals based on identified risks and needs. Select all that apply(Required)

Community Linkage

Early Literacy Development

Employment

Education

Parenting

Financial Literacy

Housing

Mental/Physical Health

Parent Engagement

Transportation

Youth Development

Input was provided by(Required)

If other please specify(Required)

Staff Signature(Required)

Electronic Signature(Required)

I accept this electronic signature

The RING assessment captures all risks and needs of those students who are working with an FFC Advocate. The assessment must be completed within 30 days of case assignment or to initiate program transfer. The advocate is responsible for completing the first one and the Director of Programs and Operations for the last one.

RING Assessment

Phone: 407.422.4615 | Fax:
2265 Lee Rd Suite 203, Winter Park, FL 32789
Email: info@foundationforfosterchildren.org

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