iFoster Smooth Transitions Resource Referral Form
YOUTH INFORMATION
Legal First Name
Legal Last Name
Preferred Pronouns
Date of Birth (MM/DD/YYYY)
IMPORTANT - Youth must have a valid email to be able to participate as they will receive important application information via email. Mobile phone will be used for text notifications.
Youth Email
Youth Mobile Phone Number
Current Housing Situation (Select situation that most fits your current situation)
Please select...
Permanent housing (i.e. living on own, with roommates or adult supports)
Temporary, but need permanent (i.e. dorm, staying with friends/family, transitional housing)
Urgent housing need (i.e. couch surfing, living car/street/shelter)
Address (Street Address or n/a if unknown)
Apartment or Unit Number (n/a if none)
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
What is the county you aged out of foster care?
YOUTH RESOURCE NEEDS
In addition to applying for Guaranteed Income, do you have resource or supportive service needs? Please select each that apply.
Housing
Please select...
YES - I need housing in the next 30 days
YES - I need housing in the next several months
NO
Daily Expenses
Please select...
YES, I'm behind on my bills and owe money
YES, I'm worried about covering all my daily expenses
NO
Technology and Communications
Please select...
YES, I need free Phone or Internet service
NO
Health/Well-Being Support
Please select...
YES, I need help with my health/mental health/well-being
NO
Government Benefits (i.e. MediCal, CalFresh, CalWorks, WIC)
Please select...
YES, I need help enrolling in benefits I'm eligible for
NO
Education
Please select...
YES, I need academic help (i.e. tutoring)
YES, I need financial aid help for college/post-secondary
YES, I need academic and financial aid help
NO
Employment
Please select...
YES, I need a job (or a better or different job/career)
NO
Legal, Finance, and State ID
Please select...
YES, I need legal help
YES, I need help getting my government ID
YES, I need help with budgeting, banking or my credit
NO
Child Care
Please select...
YES, I or my partner need child care or help paying for child care
NO
Other - Please let us know what other need you may have.
REFERRING PARTY
Please indicate your relationship with the Youth being referred
Please select...
SELF
County Social Worker
CBO Case Worker
Attorney
TAY AmeriCorps Intern
If a social worker or other supportive adult it filling out this form on behalf of the above named Youth, please provide the following information
First Name of Referrer
Last Name of Referrer
Email
Phone
Thank you! We will be in touch within 3 business days!
Questions? - Call or email and one of our team members will be in touch asap:
Phone:
855-936-7837
Text: 530-550-8001
Email support@ifoster.org
Contact Information
iFoster Smooth Transitions Resource Referral Form 
iFoster Smooth Transitions Resource Referral Form