College Fellows Referral Form for Colorado
Guiding Youth in Foster Care to Success in College

Youth who age out of foster care have rocky statistics. 7% earn an associate’s degree and 3% earn a bachelor’s. While 70% want to go to college, 30% apply. Those who do attend often have limited family support and drop out.

Our Education Advocate provides the guidance necessary so youth coming from foster care succeed in college. We interview potential students, invite them into college settings, and provide quality guidance and peer-to-peer support.

The program is open to 10th, 11th, and 12th graders, students gaining a GED, high school graduates, and college students.

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Your Name: *
Your Email: *
Student Referral Information
Student First Name *
Student Last Name *
Student Date of Birth
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/
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/
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Student Grade *
What are the student’s interests and goals?  What does he/she like to do and dream of doing? *
What are some of the student’s personality traits?  How would you describe him/her to a stranger? *
What does the student's support network look like? Who does the student go to most for support? *
Is there any other information needed, to better serve the student well? *
Describe the student’s academic success and struggles so far (detail is good). *
Points of Contact for the Youth:
Caregiver's Name:
Caregiver's Address:
Caregiver's Phone:
Caregiver's Email:
Social Service County *
If you selected "Other" (above), please type name of County:
Social Service Foster Care Worker Name
Social Service Foster Care Worker Email
Social Service Foster Care Supervisor Name
Social Service Foster Care Supervisor  Email
Social Services Adoption Worker Name
(if applicable)
Social Services Adoption Worker Email
Social Services Adoption Supervisor Name
(if applicable)
Social Services Adoption Supervisor Email
Guardian ad Litem or CASA Name
(if applicable)
Guardian ad Litem or CASA Email
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