Futures Forward Program Application Spring 2026

The Futures Foundation Program Application

Spring 2026 | Program Support Request
Program Participant Information
Participant Name*

First NameLast Name
Participant Email (if applicant doesn't have an email please write none)*
example@example.com
Participant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
OaklandMacombWayneOther (please specify)
African AmericanAmerican Indian/Alaskan NativeCaucasianEast Asian (China, Hong Kong, Japan, Macau, North/South Korea, Taiwan, Philippines, Vietnam, etc.)HispanicMiddle EasternPacific IslanderSouth Asian (India, Pakistan, Nepal, Sri Lanka, Bangladesh, etc.)Two or More RacesPrefer not to RespondOther
If Other, please state:
Participant Date of Birth*

MonthDayYear
Date
Participant Age
FemaleMaleOther/Non-ConformingChoose Not to Respond
If Other, please state:
YesNo
If not English Proficient, please provide what language is preferred.
Current StudentLess than High SchoolHigh School Diploma or EquivalentSome CollegeAssociate DegreeTechnical TrainingBachelor's DegreeOther
If Other, please state:
IEP504 PlanIPOS (Individual Plan of Service)BIP (Behavior Intervention Plan)Other
If Other, please state:
StudentPart-timeFull-timeNoneDisabled or Unable to Work (designated by a state or federal agency)Prefer not to respondOther
If Other, please state:
$0-$25,000$25,001-$45,000$45,001-$60,000$60,001-$80,000$80,000 +N/A
Intellectual DisabilityAutism Spectrum DisorderDown SyndromeCerebral PalsyOther
If Other, please state:
Lives with FamilyIn a Licensed Home/Care FacilityGroup HomeIndependently in an Apartment or HomeOther
If Other, please state:
YesNo
If yes, please share the Supports Coordinator's/Case Manager's Name and Title *
Please share the Agency where the Supports Coordinator works (Example: Oakland Family Services). *
Please share the Supports Coordinator Email Address*
example@example.com
Please share the Supports Coordinator Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Guardian or Responsible Party Information
Guardian/Responsible Party Name*

First NameLast Name
GuardianParentOther
If Other, please state:
Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guardian Email*
example@example.com
Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
FemaleMaleOther/Non-ConformingChoose Not to Respond
If Other, please state:
YesNo
If not English Proficient, please provide what language is preferred.
African AmericanAmerican Indian/Alaskan NativeCaucasianEast Asian (China, Hong Kong, Japan, Macau, North/South Korea, Taiwan, Philippines, Vietnam, etc.)HispanicMiddle EasternPacific IslanderSouth Asian (India, Pakistan, Nepal, Sri Lanka, Bangladesh, etc.)Two or More RacesPrefer not to ResponseOther
If Other, please state:
Current StudentLess than High SchoolHigh School Diploma or EquivalentSome CollegeAssociate DegreeTechnical TrainingBachelor's DegreeOther
If Other, please state:
StudentPart-timeFull-timeNoneDisabled or Unable to Work (designated by a state or federal agency)Prefer not to respondOther
If Other, please state:
YesNo
RenterHomeownerOther
If Other, please state:
$0-$25,000$25,001-$45,000$45,001-$60,000$60,001-$80,000$80,001 -$100,000$100,001-$120,000$120,001-$140,000$140,001+
Total Number of People Living in Household:*
MedicaidMedicareSection 8 Housing Choice VoucherSNAP (MI Bridges Card)Social SecurityUnemployment BenefitsWICOther government assistance
If Other, please state:
Program Support Request Information

Detailed Financial Request Application
Everyday and Home Basics (furniture, equipment, etc.)Technology (fosters digital skilling, communication, learning, training, etc. Ex: tablets, app subscriptions, etc.)Quality of Life Experiences (recreation, camp, classes, etc.)Other
If Other, please state:
Please state the dollar amount being request*
Program Support Details: What is being requested? Please provide as much detail about the item/service/request as possible to best support your need. (150-400 words)*
Please describe how this request will improve overall quality of life or improved well-being and circumstances. Share if this will impact family members, too. Please provide as much detail as possible to best support your need. (150-400 words)*
In your household budget, please share the amount of monthly assistance remaining for personal items after all expenses are paid.*
What other resources have been explored to help with expenses? If some support has been secured, please provide those details.*
YesNot applicableOther
If Other, please state:
YesNoPending
If yes, please upload the quote/estimate here:

Cancelof
YesNoPending
If yes, please upload the recommendation here:

Cancelof
Please provide any further detail that would be helpful in better understanding the request. *
Consent to Receive Services
As a client of the Futures Foundation, I, Name* consent to the following on behalf of Name :

- Receive services/support from the Futures Foundation
- Fully defend, indemnify, and hold harmless the Futures Foundation from any and all claims, lawsuits, demands, causes of action, liability, loss, damage and/or injury, of any kind whatsoever ( including without limitation all claims for monetary loss, property damage, equitable relief, personal injury and/or wrongful death), whether brought by an individual or other entity, or imposed by a court of law or by administrative action of any federal, state, or local governmental body or agency, arising out of, in any way whatsoever, any acts, omissions, negligence, or willful misconduct on the part of the Futures Foundation or by its officers, owners, personnel, employees, agents, contractors, invitees, or volunteers. This indemnification applies to and includes, without limitation, the payment of all penalties, fines, judgments, awards, decrees, attorneys’ fees, and related costs or expenses, and any reimbursements to The Futures Foundation for all legal fees, expenses, and costs incurred by it.
- The release of my personal information such as name, phone, county, birth date, etc. and other related case information to the appropriate partners for any/all interagency referrals, services, or other providers as needed to provide comprehensive support as deemed necessary by the Futures Foundation and its staff.
- Was read/explained/provided the Program Support Disclosure & Privacy Guide as well as the Notice of Conflict of Interest Policy.
Please sign one of the following signature request lines that best meets your description.

*If you are a Supports Coordinator or Case Worker and have consent from your individual and their guardian/parent and want to attached that communication, please do so below and sign in the appropriate field.

Thank you.
Guardian/Responsible Party Signature

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Supports Coordinator/Case Worker Signature

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Individual/Applicant Signature

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Date

MonthDayYear
Date
If signing on behalf of client and/or guardian, please attached the email providing consent for you to sign on their behalf.

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Should be Empty:

The Futures Foundation Program Application

Program Participant Information

Guardian or Responsible Party Information

Program Support Request Information

Consent to Receive Services