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Resident Follow Up
DISCHARGED RESIDENT FOLLOW UP
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DATE/TIME OF CHECK IN
*
Date
Time
STAFF COMPLETING THIS FORM
NAME OF YOUTH
*
First
Last
AGE OF YOUTH
WHAT IS THE YOUTH'S CURRENT PLACEMENT?
Foster/Adoptive Home
Residential Facility
Independent Living/Older Youth Program
Homeless
Unknown
Other
EXPLAIN
APPROX. HOW LONG AGO DID THE YOUTH DISCHARGE FROM HOC?
1-3 months ago
4-6 months
7-9 months
10-12 months
More than 1 year
WHAT IS THE YOUTH'S JOB STATUS?
Working part time
Working full time
Currently applying for jobs
Unemployed and needs support
Does not apply
PLACE OF EMPLOYMENT
LENGTH OF EMPLOYMENT
PLACE OF EMPLOYMENT
LENGTH OF EMPLOYMENT
WHAT IS THE YOUTH'S EDUCATION STATUS?
Current student
High school graduate/diploma
Currently not enrolled
Dropped out
CURRENT LEVEL OF EDUCATION
Middle school Student
High school student
College student
YOUTH'S PERFORMANCE IN SCHOOL
Average/above average performance overall
Good grades but behavior is concerning
Poor grades but no behavior concerns
Grades & behavior are concerning
WHY ISN'T THE YOUTH ENROLLED OR PARTICIPATING IN SCHOOL AT THIS TIME?
WHAT CIRCUMSTANCES LED TO THE DROP OUT?
WHAT IS GOING GOOD FOR THE YOUTH? (progress, positive updates, things to look forward to)
WHAT IS THE YOUTH STRUGGLING WITH? (difficult circumstances, poor performance, mental health concerns, etc)
IS THERE ANYTHING HOC CAN DO TO SUPPORT OR ASSIST THE YOUTH AT THIS TIME?
CURRENT CARETAKER UPDATE (include details from the staff, guardian or caretaker of the youth)
ADDITIONAL FEEDBACK
Submit
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