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Guiding Hands Referral Form
The Guiding Hands program delivers support to aged out youth and youth in group homes: www.thehandsandfeet.org
For more information email makayla@thehandsandfeet.org
or call/text Makayla at 319-530-3375
* Indicates required question
Your Email
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Your answer
Name and Relationship of person filling out form and contact information
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Your answer
Name, Age, & Gender of youth
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Your answer
Have they aged out of the foster care system or are they currently in a group home?
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Aged Out
Group Home
Neither
If they are currently residing in a group home, please list where. (Put NA if Aged Out)
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Your answer
City where youth resides
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Your answer
Youth's phone number
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Your answer
Please share any information regarding the youth's circumstances and why they could benefit from the Guiding Hands Program.
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Your answer
How did you hear about us?
Your answer
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