HTAC Impact Follow-Up: Sharing the Success

1

Who is completing this form?

Guardian ad Litem

Volunteer

CAM

Foster Parent/ Caregiver

Case Manager

Self (Teen/ Youth who aged out)

2

Name of Person Completing Form* This field is required.

First Name

Last Name

3

Email of Person Completing Form* This field is required.

example@example.com

4

Phone Number of Person Completing Form* This field is required.

Please enter a valid phone number.

5

First Name of the child or youth who received support* This field is required.

6

Last Name of the child or youth who received support* This field is required.

7

What specific support was provided? (e.g., Summer camp fees, laptop, rent assistance, graduation fees, etc.)

8

How much did this support improve the child's (or your) current situation?(1: Little impact – 5: Life-changing)

9

If this support was for a teen aging out, which area did it help stabilize most?

Housing/Safe Shelter

Education/ Job Training

Transportation

Daily Essentials (Food/Utilities)

Other

10

Tell us about a positive moment that resulted from this support.We love hearing how these resources helped! Your stories help us show donors the real-world impact of their gifts.

11

Would you like to share a photo of the item/activity?Photos of smiling faces (with permission!) or the impact in action help us tell our story. You can also upload a receipt here if required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

12

Are there any other immediate needs we should be aware of?

13

Can we share your "Success Moment" anonymously to inspire others to give?

Yes, feel free to share!

No, please keep this private