YouthBuild Charter School of Californoa: Immigrant Resource Support Form

We understand that many in our immigrant community do not feel safe leaving their homes right now due to the increase in ICE raids in California. Our Building Hope Crisis Fund can help by providing you with direct assistance in the form of grocery deliveries, rental assistance, legal aid, transportation, and more. Please fill out this form and someone will respond within 1-2 business days.

Para traducir este formulario al español, seleccione español en el menú desplegable de idiomas en la parte superior derecha.

Contact Information

Please complete as much information in the form below as you feel comfortable providing. We need to have at least one contact method for you (either phone or email.)

First Name*

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Answer required for "Email"

Mobile Phone

Number Required

Home Phone

Number Required

Work Phone

Number Required

Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Select the option that best describes you:*

Answer required for "Select the option that best describes you:"

If you are a parent/guardian of a student or family member of a staff member, please provide their name below and describe your relationship:

Answer required for "If you are a parent/guardian of a student or family member of a staff member, please provide their name below and describe your relationship:"

Check any of the following items you need support with:*

Answer required for "Check any of the following items you need support with:"

Groceries/ Food Delivery

Rent/ Housing

Hygiene Supplies/ Essentials

Clothing

Legal Aid

Transportation

Other (please describe below)

What is your preferred contact method?*

Answer required for "What is your preferred contact method?"

Phone Call

Text Message

What is your preferred language for communications?*

Answer required for "What is your preferred language for communications?"

English

Spanish

Other:

Please provide a brief description of your situation and what you need support with:*

Answer required for "Please provide a brief description of your situation and what you need support with:"

Please fix the highlighted areas below before submitting.

YouthBuild Charter School of Californoa: Immigrant Resource Support Form