Passport to Careers

Foster Care Form

FOSTER CARE INFORMATION

Indicate foster care placement type:

State DependentFederal RefugeeTribal Dependent

State:

Service provider:

Tribe name:

Date of last placement:

STUDENT INFORMATION

First Name:

Middle Name:

Last Name:

Date of birth:

Email:

Mobile Phone Number:

Home Phone Number:

SSN

Address (Street):

City:

State:

Zipcode:

I am interested in:

CollegeApprenticeship or pre-apprenticeship

Authorization to Release Information

Authorization to Release Information:

I authorize the recognized staff of the Department of Children, Youth & Families; tribal foster care; federal foster care; SETuP; Labor and Industries; and any nonprofit organizations contracted with the Washington Student Achievement Council (WSAC) to provide verification of eligibility or services for the Passport to Careers program to release and receive information regarding my foster care status; college, pre-apprenticeship, or apprenticeship enrollment; financial aid; and academic standing to and from WSAC and Passport-eligible colleges, pre-apprenticeship programs, and apprenticeship programs. I understand I may be asked for additional information from WSAC, the program administrator.

Student's signature:

Date:

If you have any questions, please contact ANEW Passport program.

We are here to help: passport@anewcareer.org

Information from Passport Intake Form

Who is filling out this form?

Name

Relationship to the Student

Phone

Best Description

Contact Information