Foster Youth Exit Survey Logging
What is today's date?
What is the youth's first name?
What is the youth's last name?
What is the youth's date of birth?
What is the youth's age?
What is the youth's email address?
What is the youth's race?
If Other, please specify:
What type of placement is the youth CURRENTLY in?
For what reason is the youth leaving state's care?
Survey Completed By:
Where will the youth be living upon exit?
If Other:
If youth will be living in own apartment, did they obtain apartment through a subsidized program?
If Yes, which one? (Scholar, Project Life, Etc.)
Did the youth leave state’s care at any point after turning 18 and later request to return to care?
Does the youth have children or are they expecting a child?
If youth has children, with whom will the children be living when the youth exit’s care?
What is the highest grade the youth has completed?
Has the youth earned a postsecondary credential or certificate?
If yes, which one?
Is the youth currently attending an educational program?
If yes, what type of program (high school, GED program, college, vocational program, etc.)?
If the youth is currently in college, what is their classification.
Has the youth ever been charged with a crime as an ADULT?
Does the youth currently have a bank account?
Approximately how much money does the youth have saved in all places?
Is the youth currently employed?
If yes, How long has the youth been employed at their CURRENT job?
If yes, is the youth working full-time or part-time?
If yes, Is the youth earning more than the state minimum wage per hour ($7.25)?
Does the youth have an original birth certificate, social security and a state issued ID?
Does the youth have a Driver’s License?
If no, does the youth have Driving Learner’s Permit?
Did the youth complete a Driver’s Education course?
What is the youth’s primary mode of transportation?
Is the youth currently taking any psychotropic medications?
If yes, do you plan to continue taking medication after leaving care?
Does youth feel prepared to live independently (pay your own bills etc.)?
Why or why not?
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CHFS Application Name