Silver Lining Mentoring Mentee Referral

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Silver Lining Mentoring matches DCF-involved youth with a one-to-one, screened and trained volunteer mentor. This volunteer commits to meeting with that young person for a few hours per month for at least one year.

This opportunity is specifically for youth 7+ and who are impacted by foster care/out-of-home experience, involved with DCF within the Greater Boston area, and eligible for 3 months of Family Network funding. If the youth is not involved in DCF or eligible for funding, please still complete the survey and a team member will contact you shortly.

Please note that Silver Lining mentors are a different resource than therapeutic mentors, as they do not participate in youth treatment plans nor work directly with the provider team.

This form is used to clarify questions surrounding mentee eligibility for the Silver Lining Mentoring Community Based Mentoring program. Please fill out the following questions to the best of your knowledge. This should take approximately 15 minutes to complete. Please don't hesitate to contact SLM staff using intake@silverliningmentoring.org with any questions regarding this update.

Referrer Information - Page 2 of 7

Referrer First Name

Referrer Last Name

Referrer Email Address

Referrer Phone Number

Please Describe your relationship with the young person (Select all that apply)

Other Explained (Relationship to Young Person)

Guardian/DCF Information - Page 4 of 7

DCF Information

If you described your relationship with young person as DCF Guardian/Case worker on Page 2 of the form, DCF work name and contact information has been recorded.

DCF Worker First Name

DCF Worker Last Name

How long has this DCF worker known the youth?

DCF Worker Phone Number

DCF Worker Email Address

Guardian Information

If you described yourself as DCF or Non-DCF Guardian on page 2, Guardian name and contact information has already been collected.

Guardian First Name

Guardian Last Name

Guardian Relationship to Youth

DCF Worker/SupervisorClinical/Site StaffOther

Other Explained (Guardian Relationship to Youth)

Guardian Phone Number

Guardian Email Address

Youth Information (Youth is own guardian)

Edit section title

You have chosen that you are your own guardian on page 3 and are filling out this document for yourself. Your contact information has already been recorded.

Edit section title

Youth Phone Number

Youth Email Address

Family Networks Funding - Page 5 of 7

SLM is a contracted provider of DCF with a daily rate of $39.14 for a minimum of 3 months upon being placed on our matching waitlist. Funding can be made through the Family Networks lead (completed through the Silver Lining Mentoring application). A member of SLM will follow-up with FamilyNet to confirm if funding is available.

To the best of your knowledge, is the potential mentee eligible for Family Networks funding?

YesNoUnsure

Have you spoke to the Family Networks LEAD or DCF worker regarding funding approval?

YesNo

If Known:

Family Networks Lead First Name

Family Networks Lead Last Name

Family Networks Lead Email Address

Family Networks Lead Phone Number

Family Network's Director/Supervisor Name

Family Network's Director/Supervisor Email Address

Family Network's Director/Supervisor Phone Number

Match & Technology Access - Page 7 of 7

We expect our matches to meet 1:1 and in the community. SLM is able to support virtual and hybrid mentoring if needed. Virtual mentoring includes mentees connecting with their mentor via phone and video chat roughly once a week. SLM is committed to working with matches to meet specific needs/accommodations.

Does the young person have access to a personal device and internet to connect with an SLM mentor virtually?

YesNoUnsure

Are there any concerns with this young person meeting privately or out in the community with a volunteer mentor?

YesNoUnsure

Is there a caregiver or staff person able to support the meeting (if needed) to facilitate the virtual match in meeting once a week, for up to an hour together at a time?

YesNoThe mentee will not require support to access virtual meeting

If match visits need to be supervised/on grounds, what would be needed to support a match during off campus visits?

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