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PDX Bridge referral form
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URL
This field is for validation purposes and should be left unchanged.
Referrer information
Agency contact (your name)
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Referring agency (e.g. DHS, DJJ, or ILP)
Your phone number
Your email
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Student information
Student's birthdate
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Month
Day
Year
Student's name
*
Student's email
Student's contact number (can be through agency if needed)
*
Current educational placement: school/program
Student meets minimum 9th grade reading level through
*
Choose an option
A passing GED® Reasoning Through Language Arts score of 145 or higher
A passing Reading Essential Skills SBAC score
A passing Reading Essential Skills work sample
Other
What other way does the student meet the minimum 9th grade reading level?
*
We aim to work with students who could most benefit from a supported transition to college. Check all that apply below. Student has experienced
Foster care
Adjudication (involvement in the justice system)
Homelessness or housing insecurity
Other
When is the student projected to graduate with a GED® or diploma?
*
Please describe why you think this student will benefit from this program, and describe what traits they possess that will help them make the best of this opportunity?
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