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PASSPORT INTAKE FORM

PASSPORT TO CAREERS PROGRAM

The Passport to Careers program can provide you with a scholarship toward a college education or apprenticeship, as well as support services to help you meet you education and career goals.

You are eligible for Passport financial assistance and other support services if you experienced:

Foster care at any point between the ages of 13 and 21.
Unaccompanied homelessness during the prior academic year.

You must meet the following requirements to participate in Passport program:

Be a resident of Washington State*
Enroll at least half-time in an eligible institution of higher education, or a recognized pre-apprenticeship or registered apprenticeship program in Washington State, before turning age 22.
Not yet have earned a Bachelor's degree.
Not pursue a degree in theology.

*If you are in ICPC and not a Washington resident, contact WSAC.

Who is filling out this form?

Please enter the name here who is filling out this form. If we have trouble contacting the student or have follow-up questions we will use this information

Please enter your name:

Relationship to the Student

For example: parent: counselor, service provider

Email

Phone

Please select one of the following statements that best describe you:

I have been in foster care between the ages of 13 and 21I am not in High School and Identify as Unaccompanied HomelessI have been in tribal foster care between the ages of 13 and 21I am in High School and Identify as an Unaccompanied Homeless youth

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

We are here to help: passport@anewcareer.org

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:

STUDENT INFORMATION

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

Passport to Career Program

Dependent/Ward of the Court Verification

STUDENT INFORMATION

Date and age dependency was established:

Amount of time spent in care (years/months):

Date of last placement:

Name of federally recognized tribe:

TRIBAL REPRESENTATIVE INFORMATION

First Name:

Last Name:

Title

Email:

Phone Number:

Address (Street):

City:

State:

Zipcode:

This statement is to confirm the following:

The above-named person was in the care of the tribal foster care system of the above-named tribe in Washington state, and placed in and out-of-home care at any time since turning 13 and before turning 21. I certify that the information provided in this document is true and accurate.

Authorized tribal representative signature:

Date:

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

We are here to help: passport@anewcareer.org

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PASSPORT INTAKE FORM

Passport to Careers Foster Care Form

Passport McKinney Vento Housing Questionnaire

Passport to Career Program

Dependent/Ward of the Court Verification

Passport to Apprenticeship