RIT Education Programs Referral

Thank you for your interest in participating in Refugee & Immigrant Transitions' (RIT) Education Programs.

BEFORE YOU FILL OUT THIS FORM, PLEASE NOTE:
RIT DOES NOT find housing, provide job placement, or offer legal immigration services. If you'd like case management support (such as interpretation, connection to community resources, etc.), please contact: casemanager@reftrans.org.

Please note that filling out this referral form does not guarantee enrollment in our programs. Priority goes to those who are low income, newly arrived, preliterate and beginning levels of English, entering into the workforce and/or Oakland parents of young children (18 months to 5 years old). An RIT staff member will contact you about program capacity and your enrollment status.

Confidentiality Disclaimer: RIT will protect client information and maintain confidentiality. Information submitted through RIT referral forms is transmitted in an encrypted manner through FormAssembly and stored in the secure database (Salesforce). None of the information will be shared without client permission.

If you are filling in this form on behalf of someone, please obtain their written (or verbal) consent before filling in this referral form.

RIT Programs

Program participation requirements:

1-1 Tutoring: 6-month commitment (adults) or 9-month commitment (youth).
Adult Classes: In-person English assessment required 2x/year.

Please select the program(s) that you are inquiring about:

Adult English Class only for parents with small children (in-person class in Oakland)Adult Class Citizenship - This class is intended for 1-2 years of study. Not if your interview is in 1-3 months. (online only for those in the Bay Area)Adult Class General English (online option for those in the Bay Area + in-person classes in San Francisco and Oakland)Adult Class: Childcare for toddler (18 months - 5 years old) during Oakland in-person class (only for Oakland in-person class students).Adult English Class: Driver Learner's Permit (online only for those in the Bay Area). Dari/Pashto: women only. Spanish: all genders.Adult Home-Based/One-on-one tutoringYouth Home-Based/On-on-one tutoring/mentoringNewcomer Youth school enrollment support & resources (Bay Area wide)

Client Info

If you're filling in this form for yourself, please put your info. If you're filling in this form for someone else, please put that person's info.

First Name

Last Name

Guardian/Parent Name (For students who are younger than 18 years of age)

Guardian/Parent, do you give RIT permission to contact the student? (For students who are younger than 18)

Gender

Date of Birth (MM/DD/YYYY)

Phone

Address: Street, House, Apartment #

Address: City

Address: State

Address: Zip

Country of Origin

Date of Arrival in the U.S. (MM/DD/YYYY)

Languages spoken

Immigration Status (Note: RIT serves all individuals regardless of status)

If received asylum, please put date received

IF OTHER: describe here (if the client is a US citizen, please note here if they are a former refugee/asylee/SIV)

For those who have USCIS documents: A Number (official immigration number/USCIS number). Put N/A if does not apply or unavailable. (It is okay if you do not have an A Number; you will still receive our services).

A Number is found on a Employment Authorization Document, Green Card or Visa. Please note that students will be asked for this documentation, if available to them, upon program intake.

Do you (or the person you're referring) have children 0-8?

School Name

School District

Years of Education in Home Country

Native Occupation or Job in Home Country

Currently working?

Looking for work?

Add any notes here:

Please fill in:

Your name & Contact information

If available, kindly attach copy of green card, I-94, or Employment authorization document (for youth and adults). NOTE: Students will be asked for these documents (if available to them) upon program intake. Please do not attach any documents that might contain confidential information about physical/mental health.

Contact Information