Transition to Adulthood

Any foster youth age 14 to 24 in out-of-home care (foster care, relative care, non-relative care, and group homes) or EFC/PESS residing in or managed from Orange, Osceola, or Seminole County is eligible to work with our team of Advocates

Transition to Adulthood: Connecting Youth to Community Resources and Mentorship. Connecting youth to available community resources, programs, and assistance through mentorship and personalized support. Our team of Advocates will provide one-on-one guidance and consultation in navigating available community resources.

FFC reserves the right to modify services and policies, at any time. Processing usually takes 10-15 business days.

"*" indicates required fields

Application Date*

Submitter Name*

First Last

Submitter Phone Number*

Submitter Email*

Relation to the youth*

If other, please specify.*

Youth Information

Youth Name*

First Last

Youth Phone Number*

Youth Email*

Date of Birth*

Age*

Does the youth have children?*

Yes

Gender*

Female

Male

Ethnicity*

African-American

Asian-American

Caucasian

Hispanic-Latino

Multi-Ethnic

Placement*

Foster Home

Group Home

Relative (Not Bio Parent)

Non-Relative Parent

Other

Group Home Name*

Address where youth resides:*

Street Address Address Line 2 City State ZIP Code

Residing County*

Orange

Osceola

Seminole

Other

Grade*

School Currently Attending*

Is the youth case closed?*

Yes

N/A

Is the case likely to close or be reunified in the next two months?*

Yes

Not Sure

Is the youth employed or in secondary education? (for youth 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*

Needs - Please select all areas you hope we can assist you with

Housing

Transportation

Employment

Education

Mental/Physical Health

Parenting

Financial Literacy

Life skills development

Other

If other, please specify*

Child Welfare Team

Is the youth case managed by an state agency/case manager or by a community organization?*

Child Welfare Agency/Case Manager

Community Organization

Case Manager

Case Management Agency*

Case Manager Name*

First Last

Case Manager Phone*

Case Manager Email*

Case Management County*

Community Organization

Please specify the community organization name*

Contact Name*

First Last

Phone*

Email*

Primary Contact Information

Caregiver, mentor, family member, etc.

Primary Contact Name*

First Last

Primary Contact Phone*

Primary Contact Email*

Current Need

What's the current need?

Hidden

Career*

Hidden

Housing*

Hidden

Parenting*

Hidden

Transportation*

Hidden

Cost of request*

Hidden

Activity Provider Name*

Hidden

Activity Provider Phone*

Hidden

Activity Provider Email*

Hidden

Activity Provider Website

Hidden

Activity Provider Address*

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

Please describe the current need and how this activity would benefit the youth. Please also include any relevant information needed to process this request.*

Please attach any documentation relevant to this request

Max. file size: 50 MB.

Is this time sensitive?*

Yes

If yes, when do you need us to process this by?*

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, Orange County Commission for Children and Embrace Families.

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.

Photo/Testimony Release

Foundation for Foster Children Photo/Testimony Release: provides the Foundation for Foster Children (FFC) with permission to use photographs or testimonies provided in internal and external communications such as program newsletters and FFC marketing materials including, but not limited to, the website and print materials of FFC. Youth 18 and older must provide direct consent before services will be initiated. Consent must be provided by the caregiver, caregiver support, IL specialist, TSS, GAL or their respective supervisors before services will be initiated for youth 14-17.

Photo/Testimony Release: Consent*

I do give consent

I do not give consent

I do not have permission to provide consent

Photo/Testimony Release Statement*

By signing below, I hereby give the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein. I understand that FFC may use photographs and testimonies in internal and external communications including program newsletters and FFC marketing materials including, but not limited to, the website and print materials. I understand that compensation in any form for the use of this likeness is prohibited.

Photo/Testimony Release Statement*

By signing below, I hereby do not give the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein.

Photo/Testimony Release Statement*

By signing below, I hereby am unable to give/deny the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein.

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

Electronic Signature: Photo/Testimony Release*

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.

Liability Waiver Consent*

I have read this form and undersand that by signing this form, I am giving up legal rights and remedies. I agree to the privacay and policy.

Electronic Signature*

Please type first and last name

Electronic Signature Consent*

By checking this box you accept this electronic signature.