1 Start 2 Complete Everyone needs support. We’re so happy you reached out! Please compete the questions below and one of our staff will get back to you within our youth support hours. General Information First Name * Last Name * Legal First Name (if different from above) Legal Last Name (if different from above) Birthdate * Year Year19981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Pronouns She/Her She/They He/Him He/They He/She/They They/Them Self-Described If you marked your pronouns as 'self-described', please add your pronouns here Gender Female Male Non-Binary Two-Spirited Other If you marked your gender as 'other', please add your gender here What's your experience in care in BC? (mark all that apply to you) * When we talk about care experience at the Fed, we mean that at some point between the ages 0 and 19 you had accessed services from the Ministry of Children and Family Development or a Delegated Aboriginal Agency. This includes Foster Homes, Group Homes, Child and Youth Mental Health Services, Addiction Facilities, Community Living BC, Custody Centres, Youth Agreements, Independent Living Agreements, Extended Family Placements, or Homelessness. If you're not sure about your care experience, you can mark "I don't know," and a staff member will follow up with you. Foster Homes Group Homes Youth Agreements Independent Living Agreements Extended Family Placements Homelessness Youth Justice Residential Treatment or Support Centers I don't know Contact Information E-mail address * Please provide the best e-mail address to reach you at. If you do not have one, please leave this section blank. Cell phone Other phone Address line 1 Address line 2 City Province Postal Code What's the best way for us to contact you? Tell us a little more about you! Do you identify as being a member of any of the communities below? Check all that apply to you. Indigenous LGBTQ2S+ Disabilities Newcomer to Canada (immigrant, refugee, 2nd generation) Parent Other If you marked your community as other, please share it here. If you identify as Indigenous and you would like to share your ancestry or what nation you belong to, please feel free to. What kind of support are you interested in? Let us know what kind of support you would like from us! Select as many as you feel you need. Fed Coaching Navigating Resources Social Connection Advocacy Support What are your support needs? * Check all that apply Celebration Culture Disability Support Education Employment Financial Support Food Health and Wellness Housing Identity Legal Life Skills Mental Health Personal Growth Personal Interests Pregnancy and Parenting Relationships Rights Self Care Substance Use Transitioning from Care Other If you marked 'other' above, please specify: Is there anything else you would like to share with us? Acknowledgements Would you like to hear from us about opportunities and resources? Let us know if you would like to receive emails from us on opportunities, information and resources offered by the Fed and other youth-serving organizations around BC! Yes No Become a Fed Youth Member! Join the Fed! Youth members have priority access to all the great opportunities the Fed has to offer, they are part of our provincial family, and they help to create a better experience for their care siblings. Only youth members can vote on key decisions we make as an organization. You’ll influence all of thing things we do! Membership is free and open to youth in and from government care in BC between the ages of 14 and 24. Yes, contact me about signing up. Fed Policies * Please review the key policies related to our programs and services linked below. I have reviewed, understand, and agree to the Fed Policies I would like staff support to review the policies with me Read our Fed Policies here. Privacy and Information Consent * We are collecting your personal information to contact you about your interest in our Youth Support Program, and to invite you to participate in a program evaluation. By marking ‘Yes, I consent’ below, you give the Federation of BC Youth in Care Networks permission to collect and use your information as we described above. If you have any questions or need more information, please contact info@fbcyicn.ca. Yes, I consent.
