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By marking "yes" I am agreeing that I understand that completing this survey is voluntary and is only intended to gather my information for program eligibility purposes.

Yes
No

First Name

Last Name

What is your Date of Birth?

What is your Race/Ethnicity (select all that apply)

Asian (do you identify as: Hmong, Vietnamese, Chinese, Korean, etc-- please describe)
Black/African-American
Hispanic or Latinx (do you identity as: Mexican, Cuban, Dominican, El Salvadorian, etc-- please describe)
Indigenous/Native American
Native Hawaiian/Pacific Islander
White

Provide your email, preferably UCR email.

If you have been assigned one, what is your UCR student identification number (SID), it typically starts with the number 8.

What is your phone number?

What is your major? (it is fine to say "undecided")

What is your status?

I want to apply to UCR but I have not done so yet
I have applied to UCR but I have not heard if I am accepted
I have been accepted to UCR but I am not sure if I am going to say yes
I am an incoming first year student
I am an incoming transfer student
I am a current first year UCR student
I am a current second year UCR student
I am a current third year UCR student
I am a current fourth year or later UCR student

Were you in foster care for any period of time BEFORE the age of 13?

Yes
No

Were you in foster care for any period of time SINCE the age of 13?

Yes
No

Are you still in foster care?

Yes
No

Were you ever adopted, if so at what age?

Yes
No

Were you ultimately reunited with your biological parents, if yes at what age? If no, please briefly describe your placement history.

Yes
No

How many foster care placements did you have?

How old were you the first time you were placed into foster care?

How old were you the last time you were placed into foster care? N/A if you are still in.

If you were ever in foster care, which county heard your case (i.e., in which county were you considered a ward/independent of the court?)

Where were/will you be living before coming to UCR?

With one or more biological or adoptive parents
With a member of my extended family (e.g. aunt/uncle, grandparents)
With a sibling (i.e. sibling was your guardian or primary care provider)
With one or more foster parents
In a group home or other residential facility
Homeless
Couch surfing
With friends

Do you/are you eligible to receive Chafee? (Chafee is a California state grant awarded to a subset of foster youth and would appear on your financial aid award).
The California Chafee Grant is free money for current or former California foster youth to help pay for college or career and technical training. Chafee Grants don’t have to be paid back. To qualify, you must: Be a current or former foster youth; not have reached your 26th birthday as of July 1 of the award year; not have participated in the program for more than 5 years (whether or not consecutive). To qualify, foster youth dependency of the court must have been established between the ages of 16 and 18. Kingap youth who are or were eligible to receive Independent Living Program services, guardian placements and voluntary placements may not be eligible for the California Chafee Grant unless court dependency was established between the ages of 16 and 18. For more information go to this link: https://chafee.csac.ca.gov/SupportFiles/Chafee_factsheet.pdf

Yes
No
Unsure

Do you/are you eligible to receive AB12 (AB12 is a California policy that extends foster care benefits to age 21, sometimes it is also called extended foster care-- EFC)?
Assembly Bill (AB) 12 is the law that extends foster care to age 21 in California. If you are in a foster care placement (Department of Children and Family Services {DCFS} or Probation) on your 18th birthday, you may be eligible for Extended Foster Care. That means you can take advantage of all the services and benefits DCFS and Probation has to offer including support, funding and housing (placement). You also may be eligible for re-entry up to age 21 if you leave foster care after age 18. Youth who were in failed, adoptions, kingap care, non-relative legal guardianship, and legal guardian also have a pathway for re-entry into AB12. If you think you qualify or would like to talk with someone about your AB12 benefits, please contact.

Yes
No
Unsure

Who do you spend the holidays with?

Foster family
Biological relatives
With friends/partner/spouse
By yourself

Do you currently have a social worker?

Yes
No

Do you have a copy of your "ward of court" document?

To retrieve your ward of court document, please contact the California Ombudsperson Office or your county social worker. Please use this number 1-877-846-1602. For more information visit this website: https://www.cdss.ca.gov/cdssweb/entres/forms/English/pub379.pdf

Yes
No

If you have access to it, please upload your ward of the court document.
**California law makes it so failed: adoptions, kingap, non-relative legal guardianship, and legal guardianship cases have a pathway for re-entry and benefit from AB12. Put another way, if you have been adopted, placed in kingap, etc. and your “guardians” have told you they will not be supporting you when you turn 18, or you have turned 18 and you are under the age of 21 and they are not supporting you, you can benefit from AB12, please contact our Office if this applies to you.**

To retrieve your ward of court document, please contact the California Ombudsperson Office or your county social worker. Please use this number 1-877-846-1602. For more information visit this website: https://www.cdss.ca.gov/cdssweb/entres/forms/English/pub379.pdf

Please provide any other important information we should know about you.