Black Women for Wellness | Teen Talk Foster Youth

Black Women for Wellness | Teen Talk Foster Youth | Sex Ed Series Enrollment

Eligibility:

Youth in foster care, with open cases with DCFS, or suitably placed through probation.
Youth ages 12-17, or 18 and enrolled in high school.

Series Details

BWW's available Teen Talk Foster Youth online sex education series:

January - Winter 2025 Series

Meeting Dates: 1/13, 1/14, 1/15, 1/16, 1/17

1/21, 1/22, 1/23, 1/24

Duration: Monday - Friday,

Tuesday - Friday

Time: 4:30 PM - 5:30 PM

The information submitted in this form is kept securely by Black Women for Wellness (BWW) and is shared only with Planned Parenthood Pasadena and San Gabriel Valley who manages this enrollment system. This information will not be connected to any existing or future health records.

Upon completion of the Teen Talk Foster Youth Series, a certificate of completion will be sent to the participant and their social worker as proof of SB 89 completion.

Select the Teen Talk Foster Youth series you want to enroll in:

Select a Teen Talk Foster Youth series

Applicant Information

What is your relationship to the enrolled youth? Please provide additional information about yourself.

I am:

Applicant First Name	Applicant Last Name
Applicant Email Address	Applicant Phone Number

How can we reach you?

Would you like to be added to an email list to be notified of future Teen Talk: Foster Youth workshop series?

YesNo

How did you hear about this program?

How Many Youth Are You Enrolling? You may enroll up to 3 for the same program at once.

Page 2

First Youth Participant

Youth Information

Who is enrolling in the Teen Talk: Foster Youth program? Please provide the youth participant's information.

Youth Legal First Name

Youth Legal Last Name

Youth Email

If possible please do NOT provide a school email, because our emails might not get to you.

Youth Phone Number

Thank you for your interest in enrolling in the Teen Talk: Foster Youth program! We need a little more information from you to complete your enrollment.

Youth Preferred First Name

Provide youth's preferred first name if different than youth's legal first name

Youth Preferred Last Name

Provide youth's preferred last name if different than youth's legal last name

What county does the youth live in?

Youth Age

Social Worker Information

Who is the enrolled youth's Social Worker? Please provide their contact information.
If the youth does not have a social worker, you may enter their probation officer's information in the fields below instead.

Social Worker's First Name

Social Worker's Last Name

Social Worker's Email Address

Please note that this information will be verified to ensure all eligibility requirements are met. Submitted emails that are not affiliated with a valid government address will be screened & enrollment denied.

Social Worker's Phone Number

Thank you for enrolling a youth in the Teen Talk: Foster Youth program! We need a little more information from you to complete your enrollment.

Social Worker's County

Second Youth Participant

Who is the second youth you are enrolling in the Teen Talk: Foster Youth program? Please provide the youth participant's information.

Youth Legal First Name	Youth Legal Last Name
Youth Preferred First Name Provide youth's preferred first name if different than youth's legal first name	Youth Preferred Last Name Provide youth's preferred last name if different than youth's legal last name
Youth Email If possible please do NOT provide a school email, because our emails might not get to you.	Youth Age
Youth Phone Number	What county does the youth live in?

Who is the second enrolled youth's Social Worker? Please provide their contact information.
If the youth does not have a social worker, you may enter their probation officer's information in the fields below instead.

Social Worker's First Name	Social Worker's Last Name
Social Worker's Email Address	Social Worker's Phone Number
Social Worker's County

Third Youth Participant

Who is the third youth enrolling in the Teen Talk: Foster Youth program? Please provide the youth participant's information.

Youth Legal First Name	Youth Legal Last Name
Youth Preferred First Name Provide the youth's preferred first name if different than youth's legal first name	Youth Preferred Last Name Provide youth's preferred last name if different than youth's legal last name
Youth Email If possible please do NOT provide a school email, because our emails might not get to you.	Youth Age
Youth Phone Number	What county does the youth live in?

Who is the third enrolled youth's Social Worker? Please provide their contact information.
If the youth does not have a social worker, you may enter their probation officer's information in the fields below instead.

Social Worker's First Name	Social Worker's Last Name
Social Worker's Email Address	Social Worker's Phone Number
Social Worker's County

Thank you for your interest in our Teen Talk: Foster Youth sex education series! Please click the "Register for Class" button below to submit your application.

We look forward to meeting you soon!

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