Her_Haven_Independent_Living

Thank you for your interest in Her Haven. This application is for young women ages 18-25 transitioning from foster care, group homes, or state custody who are seeking safe, supportive, and independent living. Please complete all sections and attach the required documentation.
Section 1: Personal Information
Full Name
Date of Birth

MonthDayYear
Date
Phone Number
Email Address
example@example.com
Current Address
Emergency Contact Name Number
Section 2: Background Information
Are you currently aging out of foster care or group home?
If No, Please explain your current status
If No, please explain your current status
Name of Foster Care Agency or Group Home if applicable
Date of Exit or Expected Exit

MonthDayYear
Date
Do you have any dependents If so please list their names and ages
Have you ever been convicted of a crime?
If Yes, Please explain
Section 3: Education and Employment
Are you currently enrolled in school or training
Name of School or Training Program
Employment Status
Current Employer if applicable
Please provide a short statement explaining why you want to join Her Haven and How you hope this program will support your personal and professional goals. (Attach additional pages if)
Section 5: Required Documents Checklist
Required Documents Checklist

State ID or Driver's LicenseProof of Income or School EnrollmentBackground Check or Referral (If applicable)Personal Statement or Interest LetterDocumentation of Foster/Group Home Status
File Upload

Cancelof
Section 6: Signature
Applicant Signature

Clear
Date

MonthDayYear
Date
Should be Empty: