Defined Program

Will the child be in foster care or extended foster care as of June 3, 2019? *

Yes No

Will the child be between the ages of 14 and 21 as of June 3, 2019? *

Yes No

Will the child be available EVERY Monday evening, 6/3-7/8, from 7-9pm? *

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? *