Defined Application

Name of Caregiver (if child is still in foster care) *

Will the participant be in foster care/extended foster care/aged out of foster care as of July 7, 2022? *

Yes No

Will the child be between the ages of 14 and 21 as of July 7, 2022? *

Yes No

Will the child be available EVERY Thursday, 7/7-8/11, from 4-5:30pm ? *

Yes No

Will the child have transportation to and from each weekly meeting? *

Yes No

Please provide a brief summary as to why the submitted individual should be considered for the Defined program: *

Are there specific behaviors or triggers we many need to know regarding participation in the DEFINED Group? If yes, please describe. *

Does the applicant have any food allergies or restrictions? If yes, please list. *

In the words of the teen or young adult, describe why you would like to attend/participate in the DEFINED Group? *