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.

YesNo

Section 2: Referral Information

(List the contact that referred you to our program, if applicable)
How did you hear about our housing program? (Select one)*
Referral Organization
Referral Name
Relationship
Referral Phone Number
Please enter a valid phone number.
Referral Email
example@example.com
Name of person completing the application, if different than the applicant: Skip this area if filling out the application for yourself.

First NameLast Name
Organization/ Relationship to Applicant:
Relationship or Organization
Phone Number
Please enter a valid phone number.
Email
example@example.com
Is the youth available to fill out the application on their own?

YesNo
If no, why?

Youth is incarceratedYouth is hospitalizedYouth has no access to the internet; please have youth call (775) 747-2073 to set up a tour.Other
If incarcerated; where/ what charges?
Expected release date:

MonthDayYear
Date
If hospitalized; where/ reason for hospitalization?
If other; specify:

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 agreeI do not agree
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 agreeI do not agree
I understand that false statements or information are cause for non-acceptance to NYEP's Community Living Program.*

I agreeI do not agree
Additional Documentation (if applicable) 1. Recent Psychological/ Behavioral Evaluations 2. Social History Report 3. Incident or Police Reports from the past 90 days (if applicable)

Cancelof
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.
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Community Living Program Application for Admission

Section 1: Applicant Information

Alternative Contact Information:

Emergency Contact Information:

Section 2: Referral Information

Section 2: Applicant Wellness

Section 3: Applicant Education, Employment & Volunteer History

Section 4: Applicant Readiness and Intentions

Section 5: Applicant Agreement

Application Agreement and Signature