Revised Application Form

  • Community Living Program Application for Admission

    Revised 10/2024

  • Thank you for your interest in NYEP's Community Living Program (CLP). Before proceeding with your application, it’s essential to review the program’s strict eligibility criteria and requirements outlined below to ensure this program aligns with your goals and readiness.

    If You Are Referring a Young Person to the Program:

    Please carefully review the eligibility criteria and requirements below to assess the suitability of the applicant. If they meet the criteria, encourage them to complete the application independently using our [application link]. If internet access is unavailable, you may provide them with a printable copy of the application, available [here], and email the completed version to cindy@nyep.org.

    About NYEP's Community Living Program (CLP):

    Located in Reno, Northern Nevada, NYEP partners with motivated young adults (18-24) ready to build skills and achieve independence. Applicants must reside in or be willing to relocate to Northern Nevada.

    Our program supports young women committed to building critical life skills and achieving self-sufficiency through structured guidance and resources.

    Applicant Eligibility Criteria:

    1. Age and Identity: Applicants must be 18-24 years old and identify as female.
    2. Family Status: Applicants cannot be pregnant, planning pregnancy, or have custody of children.
    3. Substance Use and Mental Health: Applicants must abstain from drug or alcohol use and show no current signs of psychosis.
    4. Support Needs: Applicants must desire and need support transitioning to stable adulthood.
    5. Capability: Applicants must be physically and mentally able to participate in program activities, including school, volunteer work, and employment.
    6. Commitment: A 12-24 month commitment to the program is required.

    Readiness and Attitude Expectations:

    Successful applicants demonstrate the following:

    • Motivation: A genuine desire to learn and grow.
    • Openness: A willingness to embrace change and adapt.
    • Skill Development: Commit to building life skills like budgeting, communication, and decision-making.
    • Resourcefulness: Ability to seek and use available resources effectively.
    • Self-Advocacy: Comfort in expressing needs and making decisions.
      Resilience: Willingness to learn from setbacks and challenges.

    Program Participation Expectations:

    Upon acceptance, participants must meet the following obligations:

    • Perform daily chores.
    • Handle grocery shopping and meal preparation.
    • Maintain regular email communication.
    • Manage a weekly calendar.
    • Engage in scheduled volunteer service.
    • Participate in education or job-training programs.
    • Budget and commit to savings.
    • Attend health appointments and follow recommended treatments.
    • While entry into the CLP is optional, meeting these expectations is mandatory upon acceptance.

    Application Instructions:

    Read each question carefully and respond thoughtfully. Your responses will help us understand your goals and how NYEP can support you in your journey toward independence. If you have any questions, please feel free to contact us.

    Thank you for considering the CLP, and we look forward to reviewing your application!

    Warm regards, The NYEP Team

  • I confirm that I have thoroughly read and fully understand the eligibility criteria and program expectations. I acknowledge that these criteria and expectations are non-negotiable and agree to them before proceeding with my application for NYEP's Community Living Program.

  • Section 1: Applicant Information

  • Are you completing this application for yourself?*
  • Date*
     - -
  • Date of Birth *
     - -
  • Format: (000) 000-0000.
  • Do you currently live in Northern Nevada?*
  • What is your current living situation?*
  • Are you in foster care?*
  • Have you ever been in foster care?*
  • Aged Out | Date aged out:
     - -
  • Are you currently receiving any social services or case management?*
  • In previous living situations have you ever come in contact with the following?*
  • Are you currently pregnant? *
  • Do you have children?*
  • Have you ever been convicted of a crime?*
  • Have you previously been on probation or parole?*
  • Are you currently on probation or parole?*
  • Format: (000) 000-0000.

  • Alternative Contact Information:

    (This information is being collected to assist us in locating you if you move or are living in a temporarily in another location. List the contact that is helping you through this process, if applicable.)
  • Format: (000) 000-0000.

  • Emergency Contact Information:

  • Format: (000) 000-0000.

  • Section 2: Referral Information

    (List the contact that referred you to our program, if applicable)
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Is the youth available to fill out the application on their own?
  • If no, why?
  • Expected release date:
     - -

  • Section 2: Applicant Wellness

  • Do you have Medicaid?*
  • If yes, what is your Medicaid Managed Care Plan Provider?
  • Do you have private insurance?*
  • Do you receive SSI/SSDI?*
  • Do you have a payee for your SSI/SSDI?
  • How would you rate your overall health?*
  • Do you have any medical concerns at this time?*
  • Do you have any allergies (food, medication, environmental)?*
  • Do you have any physical limitations or mobility issues that may require accommodation?*
  • Do you have a primary care provider?*
  • Format: (000) 000-0000.
  • Which of the following describes your current mental state?*
  • Is your family:*
  • Is your social network:*
  • Have you ever been diagnosed of treated for mental health conditions?*
  • Do you currently have a therapist or mental health provider?*
  • Format: (000) 000-0000.
  • Do you currently have a psychiatrist?*
  • Format: (000) 000-0000.
  • Are you currently taking any prescribed medications?*
  • Have you ever been in a treatment program for substance use?*
  • Do you drink alcohol?*
  • Do you currently use drugs?*
  • Do you currently smoke or vape? (Select all that apply)*
  • Do you anticipate needing assistance or support for any health or wellness-related issues while in the CLP?*
  • How comfortable are you with managing your own daily health and wellness needs (e.g., medication management, attending medical appointments)?*

  • Section 3: Applicant Education, Employment & Volunteer History

  • Have you obtained any of the following?*
  • What best describes your current education status?*
  • Are you willing to participate in a certificate or workforce development program ?*
  • What best describes your current employment status?*
  • Date hired
     - -
  • If not employed, what is your primary source of income?*
  • Do you have a checking account?*
  • Do you have a savings account?*
  • Do you have/use a financial app (i.e. cash app, chime etc..)?*
  • Do you have any debt?*
  • Do you currently volunteer?*

  • Section 4: Applicant Readiness and Intentions

  • Have you reviewed and do you understand the rules listed in the CLP Resident Handbook?*
  • Are you willing to follow the rules set forth by NYEP?*
  • Are you willing to sign and adhere to a Program Agreement?*
  • Are you willing to keep your word?*
  • Are you willing to to solve problems with peers in a calm, constructive and respectful manner?*
  • Are you willing to participate respectfully in activities and complete jobs with people that you might not like?*
  • Are you willing to attend 10-20 hours of structured programming weekly, in addition to personal commitments such as work and school?*
  • Are you willing to communicate respectfully with peers and authority figures even if you do not like them or agree with what they are saying?*
  • Are you willing and able to express you needs in a calm respectful manner without violence?*
  • While participating in the program, are you ready to commit to staying drug- and alcohol-free to prioritize your personal growth, maintain a clear mind, and fully engage in building a better future for yourself?*
  • Are you willing to transport yourself to appointments (walk or take the bus)?*
  • Are you able to manage your emotions in upsetting situations without acting out, making others uncomfortable, or causing a safety issue for yourself or others?*
  • Are you willing to participate fully completing daily chores?*
  • Are you willing to participate fully completing weekly meal prep?*
  • Are you willing to participate fully in weekly volunteering?*
  • Are you willing to participate fully in education and employment programs?*
  • Are you willing to attend and participate in all health and wellness appointments?*
  • Are you willing to maintain accountability with staff through regular check-ins and status reports as well as provide any requested documentation?*
  • Are you willing to follow program rules and expectations, including construction feedback and guidance from NYEP staff?*
  • Are you prepared to participate fully in a 12-24 month program, including adhering to structure and rules?*

  • Section 5: Applicant Agreement

  • I hereby authorize NYEP to receive information regarding my application and further authorize relevant outside parties to exchange and release personal records regrading my application with NYEP.*
  • I understand that I am requesting to participate in NYEP's Community Living Program, which is a gender inclusive housing program. I understand that I am agreeing to live in the same room with any other resident regardless of biological gender.*
  • I understand that false statements or information are cause for non-acceptance to NYEP's Community Living Program.*
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  • Application Agreement and Signature

    I hereby certify that I have completed this application truthfully and to the best of my knowledge. I understand that the expectations and responsibilities associated with NYEP's Community Living Program and am willing to commit to the program's duration and requirements.
  • Date
     - -
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