Inquire/Referral

Inquire/Referral

Inquire/Referral
Is this:

Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Best time to reach you?
Age

How have you been impacted by Foster Care

When will you age-out of care?

MonthDayYear
Date

Are you currently homeless?

How long have you been homeless?
Where are you currently staying?

Are you currently in high school?

It looks like you don't qualify to apply for the JEMfriends Independent Living Program. Thank you for your interest!

Tell us about your current situation:
Please check all that apply to you
Tell us about your current goals
Tell us about current obstacles keeping you from completing your goals
What are questions you have about JEMfriends that we can answer for you?

Your (Referrer) Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Best time to reach you?
Who are you referring to the JEMfriends Independent Living Program?
Referee's Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Best time to reach them?
Their Age
What is the relation between yourself and who you are referring to JEMfriends?
Why would you like to refer them to JEMfriends?
How would you prefer JEMfriends to proceed with this referral?

Please fill out the remaining questions about the person you are referring to JEMfriends to the best of your ability.
How have they been impacted by Foster Care?

When will they age-out of care?

MonthDayYear
Date

Are they currently homeless?

How long have they been homeless?
Where are they currently staying?

Are they currently in high school?

It looks like the individual you are referring doesn't qualify to apply for the JEMfriends Independent Living Program. Thank you for your interest!

Tell us about their current goals
Tell us about current obstacles keeping them from completing their goals
What are questions you have about JEMfriends that we can answer for you or your referral?

Should be Empty: