At-risk youth/Reentrant Application
We are dedicated to providing at-risk youth and justice-impacted individuals with the tools, guidance, and support needed to break cycles of hardship and build sustainable paths toward success. Through mentorship, workforce development, life skills training, and family reunification services, we strive to create opportunities that foster resilience, self-sufficiency, and long-term community impact.
Name
*
First Name
Last Name
If filling out this application on behalf of someone please provide your name and organization if applicable.
*
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Date of Birth
*
-
Month
-
Day
Year
Date
What’s your gender?
*
Male
Female
Non-binary
Prefer not to say
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Are you or the person you’re completing this form a reentrant?
*
Yes
No
If yes, date of release
Where you referred to this program?
*
Yes
No
If yes, by whom?
Please describe your current living situation
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Stable Housing
Transitional Housing
Homeless
Living with family/friends
Other
Do you have children?
*
Yes
No
If yes, how many and what are there ages?
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Current employment status
*
Employed full-time
Employed part-time
Unemployed
Self employed
Are you currently enrolled in an educational program/trade school?
*
Yes
No
If yes, specify the program
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What is your highest level of education?
*
Less than high school
High school diploma/GED
Some college
Associates degree
Bachelor's degree
Master's degree or higher
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What area(s) of support are you seeking?
*
Mentorship
Family Reunification
Workforce Development
Financial Literacy
Counseling/Emotional Support
Housing
Life Coaching
Food Security
Life Skills
Other
What are your primary goals for participating in this program?
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Do you face any immediate challenges/barriers?
*
Are there any other services you are currently receiving?
*
Is there anything else you'd like us to know about you?
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I confirm that the information provided in this application is accurate to the best of my knowledge.
*
Yes
No
I consent to being contacted by Dream Builders Foundation regarding my application and program participation.
*
Yes
No
I understand that my personal information will be kept confidential and used solely for program-related purposes.
*
Yes
No
Submit
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