Georgia Center For Resources & Support

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The Foster Care Support Foundation has a mentoring program for youth aged 10 years and older called Hope 4 Tomorrow (H4T). H4T gives youth an opportunity to have another positive, engaged person in their life who they can talk to about problems, help them set and achieve goals, and to just do fun activities with like playing ball or going to the movies.

This is a free program and the mentors will be responsible for picking up and dropping off the youth during their visit, so there are no costs or transportation requirements necessary to be involved in the program. Mentors are background checked through DHS and complete an orientation, mentor training sessions, reference checks, and an interview process before being matched with a youth. Matches are based on multiple criteria such as geographic location, personality type, hobbies, and interests.

H4T is available to youth in foster or relative care that reside in Cherokee, Cobb, Dekalb, Forsyth, Fulton or Gwinnett Counties. If your youth lives outside of these areas or is younger than 10 years old, please contact us for further information.  Mentees will have to agree to meet with their mentor for a minimum of 4 hours per month and also communicate with their mentor weekly via phone or similar method. If you know of a youth that could benefit from having a dedicated mentor and is interested in joining the Hope 4 Tomorrow Mentoring Program, please fill out the attached H4T application with the youth and email it back to This email address is being protected from spambots. You need JavaScript enabled to view it. at your earliest convenience. The application is also printed below, so if you prefer, you may simply click reply to this email, complete the form below, and send it as a response to this email. Please fill out a separate application for each youth interested in the program.

If you have any questions or concerns, please feel free to call the H4T phone line at (770) 317-3749. We look forward to hearing from you.

Best Regards,

Jordan Rayburn
Hope 4 Tomorrow Mentoring Coordinator
Cell: 770-317-3749
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Sue C. Kath
H4T Communications
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Rachel M. Ewald
Executive Director
Foster Care Support Foundation
www.fostercares.org
Phone: 770-641-9591
Fax: 770-641-3084

Mailing Address: 3334 Trails End RD NE, Roswell, Georgia 30075
Physical Address: 115 Mansell Pl, Roswell, Georgia 30076

FOSTER CARE SUPPORT FOUNDATION Hope 4 Tomorrow Mentoring (H4T) Mentee Application

To be completed by the guardian and mentee (Caseworker if applicable) - please type or print neatly

Personal Information

Youth’s Legal Name:

Date:

Guardian Name:

Relationship to Youth: __ Parent __ Relative __ Foster Parent __ Caseworker

__ Friend __Other, specify: _______________________________

Street Address:

City:

State:

Zip:

County:

Intake Date:

Per Diem: $

Home Phone:

Work phone:

Cell Phone:

Email Address:

Date of Birth:

Age:

Sex: __ Female __ Male

Ethnicity: __ White __ Hispanic __ African-American __ Asian __ Other:

Name of School:

Grade:

Emergency Contact Name:

Phone:

Please list all the members in the residing household (add additional sheet as necessary)

Name

Sex

Age

Relationship to Applicant

Is your home licensed as a: __ Foster Only __ Foster to Adopt __ Adoptive

__ Non-relative Guardianship __ Relative Guardianship/Custody __Legal Guardianship

__ Grandparent raising Grandchildren __ Group Home ­__ Other

Caregiver Date of Birth: ___/___/___ Has TPR occurred? __ Yes __ No

If yes, is the applicant in the home that will be adopting? __ Yes __ No

Is the applicant waiting for an adoptive home other than the existing home? __ Yes __ No

Applicant’s DFCS Caseworker Name:

Email Address:

Office number: Cell:

Name of Private Agency (if applicable):

Private Agency Caseworker Name:

Email Address:

Office number: Cell:

What language(s) does youth speak?

Application Questions

Please answer all of the following questions as completely as possible. If more space is needed, use an extra sheet of paper or write on the back of this page.

  1. Why do you and your youth want to participate in a mentoring program?
  2. Briefly describe your expectations for the Hope 4 Tomorrow Mentorship Program:
  3. Is youth available to meet with a mentor for a minimum of 4 hours per month and communicate with the mentor at least once a week for a minimum of one year? Please explain any scheduling issues.
  4. What is the best day(s) and time(s) to meet with your mentor on weekdays and on weekends?
  5. Is youth willing to attend training sessions with their mentor after being matched?
  6. Describe the youth’s school performance including grades, homework, attendance, behaviors, etc.
  7. Does youth have friends? Please describe his/her friendships.
  8. Is youth currently having any problems at home or at school?
  9. Has youth experienced any traumatic events, other than removal of self from biological home (i.e. death of a family member or friend, physical or sexual abuse, divorce, etc.)? If yes, please provide details.
  10. Is youth having any behavioral problems at home or at school?
  11. Can you provide any additional background information that may be helpful to Hope 4 Tomorrow in matching youth with an appropriate mentor?
  12. List a few of the jobs/professions that youth has been thinking about.
  13. What does youth like to do most in their free time? Please describe. (Reading, writing, sports, gaming, art, shopping, etc.)
  14. Is youth interested in continuing their education at a college/university or trade school after high school?

Youth’s Medical History

Name of Primary Care Physician:

Phone Number:

Medical Insurance Provider:

Insurance Policy Number:

Insurance Phone Number:

Does youth have any physical problems or limitations?

Is youth currently receiving treatment for any medical issues?

Is youth currently on any type of medication? If so, please specify.

Does youth have any known allergies? If yes, please describe them.

Does youth have any emotional issues or problems at this time?

Is youth currently seeing a counselor or therapist? If yes, for what purpose?

Therapist’s name and phone number:

Please Read Below Carefully Before Signing

The Hope 4 Tomorrow Mentoring Program appreciates you and your youth’s interest in joining the program. This application is intended as a means of gathering information on the youth for program evaluation purposes, informing the youth and guardian about the program, and gaining the consent of the guardian to allow the youth to participate in the Hope 4 Tomorrow Mentoring Program.

.After receiving this completed application from you, we will evaluate the information and contact you if the youth has been accepted to move on to the interview stage of the application process. Much of the information you supply in this application packet will be used to match the youth with an appropriate mentor. Therefore, the mentoring staff may, at times, need to access and share this information with prospective mentors and other parties when it is in the best interest of the match. However, we do not reveal names until there is an initial interest from the mentee, guardian, and mentor based first upon anonymous information provided.

Please initial each of the following.

___ I give my informed consent and permission for youth to participate in the Hope 4 Tomorrow Mentoring Program and its related activities.

___ I agree to have youth follow all mentoring program guidelines and understand that any violation on youth’s part may result in suspension and/or termination of the mentoring relationship.

___ I hereby acknowledge that youth will be transported by his/her mentor, caseworker, and/or guardian while participating in the Hope 4 Tomorrow Mentoring Program and that such transportation is voluntary and at his/her own risk.

___ On my behalf and on behalf of any youth, family, my and their estate(s), heirs or assigns, I hereby release the Hope 4 Tomorrow Mentoring Program, the Foster Care Support Foundation (FCSF), participating organizations and all of their employees, officers, directors, consultants, and coordinators from any and all liability, claims, causes of action, costs and expenses which may be or may at any time hereafter become attributable to my participation in the Hope 4 Tomorrow Mentoring Program, including any from any injury, death, or other damages to me, youth, family, my estate, heirs, or assigns that may result from his/her participation in the program, including by not limited to any arising during any transportation of him/her as a result of his/her participation in the program, and I hereby agree to hold harmless and indemnify any Hope 4 Tomorrow or FCSF mentor, program staff, or other representatives, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined by a court of competent jurisdiction. I further agree to indemnify FCSF for any and all damages caused by my or youth’s negligent, unlawful, reckless or willful actions.

___ I have received a copy of, reviewed and discussed with youth the contents of the Policies and Procedures Packet governing the rules and procedures of the Hope 4 Tomorrow Mentoring Program and agree to comply with the policies, rules, and procedures therein.

___ (Optional) I agree to allow Hope 4 Tomorrow Mentoring to use any photographic image of youth taken while participating in the mentoring program as permitted by law. These images may be used in promotions or other related marketing materials.

Although it is preferred that this application is signed before being sent back to us, signatures are not required to submit your application. There will be an opportunity to provide your signatures when we have our first meeting with you. Signatures will be required before participating in the Hope 4 Tomorrow Mentoring Program.

By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.

Guardian Signature ___________________________________ Date _________________

Print Name ___________________________________ Date _________________


Mentee Signature ___________________________________ Date _________________

Print Name ___________________________________ Date _________________

Please email your completed application to This email address is being protected from spambots. You need JavaScript enabled to view it. or mail this application to:

Foster Care Support Foundation

Hope 4 Tomorrow Mentoring Program

3334 Trails End Road NE

Roswell, GA 30075-6101