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Serenity Pathway Companion
Career Training Support
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Advocate Information
Section 1 of 5
In Progress
Advocate
Tell us about
yourself
You're the bridge. Help us understand who you are and how to reach you.
Full Name
Organization
Title / Role
Phone
Email Address
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Advocate
Your
relationship
with the participant
Select everything that describes how you know this person.
Teacher / School Staff
Social Worker
Church Leader
Mentor
Employer
Family Advocate
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Advocate
How long have
you
known them?
Your history gives us context on the depth of this referral.
Less than 6 months
6 – 12 months
1 – 3 years
More than 3 years
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Participant
Basic
information
Personal details about the participant you're referring.
Full Name
Date of Birth
Age
Phone
Email
Address
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Participant
Emergency
contact
Who should we reach if we can't get in touch with the participant?
Contact Name
Relationship
Phone
← Back
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Housing
Current
housing
situation
Select all options that describe where the participant currently lives.
Living with family
Living with friends
Renting independently
Transitional housing
Shelter
Homeless
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Housing
Housing
stability
How secure is the participant's current housing arrangement?
Stable
Some instability
At risk within 6 months
Immediate concern
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Housing
Housing
assistance
Any housing programs currently active for this participant?
Section 8
Housing Voucher
Transitional Housing
Emergency Housing
None currently
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Employment
Employment
details
Current work situation and income information.
Employment Status
Full-time
Part-time
Self-employed
Student
Not employed
Employer
Job Title
Monthly Income
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Employment
Education
level
What's the participant's highest level of education completed?
High School
GED
Some College
Trade School
College Degree
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Employment
Career
interests
What are they passionate about? Where do they see themselves going?
Goals, Interests & Aspirations
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Employment
Transportation
access
How does the participant get to work, appointments, or programs?
Personal Vehicle
Public Transit
Family / Friends
No Transportation
← Back
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Final Step
Certify &
submit
Almost there. Add any final notes and sign off on this referral.
Additional Notes
Advocate Name
Date
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Submit Referral ✓
✓
Referral
submitted!
Thank you! This referral has been saved and a full copy sent directly to your team.
📧 info@serenitypathwaysfoundation.org
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