Launch Pad Youth Inquiry Form
Male between the ages of 18-23.
Referred by county caseworker, JPO, child advocate or court order.
Capable and motivated to live independently.
Not convicted of any adult felonies.
Not in need of intensive psychiatric or D&A treatment
Date of Birth
Current Living Arrangements
County you live in now:
County of Origin: (i.e. Where you were first placed in foster care or other county involvement)
Current dependency status (if applicable)
Who is your current or most recent case worker/probation officer/advocate?
Include contact information if possible
At what age did you enter foster care/probation/county involvement?
At what age did you exit care? (if applicable)
Please briefly describe your background and history with county involvement: (i.e. foster care, dependence, probation)
Please describe why you are interested in the Launch Pad program:
Please briefly describe your goals for the future:
Should be Empty:
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