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Date and time
:
Phone Type
Safe to Call?
Are you at least 18 years old or a legally emancipated minor?
Do you have a driver's license?
Are you able to work and/or go to school at least 30 hours a week?

Answering yes to the following questions does not disqualify you from our program.

Have you used drugs in the past?
Have you abused alcohol in the past?
Do you use tobacco products?
Have you ever been convicted of a misdemeanor or felony crime?
Do you have any outstanding warrants, tickets, or pending criminal charges against you?
Are you currently on probation?
Have you ever received counseling?
Have you ever been hospitalized for a mental or physical illness?
Have you ever had a psychological evaluation?
Is there an active CYFD case involved?
Do you have a companion or service animal?
Are you currently enrolled in an education program?

Current Living Situation

Are you currently homeless as a result of domestic and/or sexual violence, dating violence, or stalking?
Are you willing to relocate to another community?
Are you currently employed?
Do you have a working vehicle?
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