Independent Living Program Application

JEMfriends Independant Living Program Application

Please fill out the entire application. All required areas much be filled out in order for your application to be processed.

If you have questions, please contact our Executive Director at liberty@jemfriends.org or call our office at 208-863-0222.
General Information
Name:*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Phone Number:*

Area CodePhone Number
When is the best time to reach you?
E-mail address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
FemaleMale

Background
Spent time in foster careCurrently in foster careAged out of foster careAging out of foster care in the next 6 monthsHomeless
Please write an autobiography. It should include your family upbringing and background*
Current Living Situation
What is your current living situation?*
How long can you stay at your current living situation?*

Education History
Some CollegeGraduated High schoolGEDCurrently enrolled in High schoolNeed to re-enroll in High School
If completed high school/ GED, what was your graduation year?
If enrolled in high school, please provide information.
YESNO
Please provide information on your college.
Describe your education goals:*

Employment History
Please provide information on your last two (2) places of employment.
Current Employment
Company Name:*
Position:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Past Employment
Company Name:*
Position:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for Leaving:*
Don't fill out if you currently work here.

Personal References

Please list two (2) references that are familiar with your character.
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
What is your relation to this person?*
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
What is your relation to this person?*

Drug/Criminal History
YesNo
If yes, please explain:
YesNo
Date of Crime

MonthDayYear
Date
Crime:
Explanation:
Name of your Probation Officer:

First NameLast Name
Phone number of your Probation Officer:

Area CodePhone Number
YesNo
YesNo
If not, please explain why:
I certify that all of the above information and the autobiography are true and accurate to the best of my knowledge, and I give permission for JEMfriends to verify the above-stated information.
Signature

Clear

Get to know you
We would like to take a moment to get to know you better! Please fill out this section with all of your favorites, then answer the questions.
Favorite Color:
Favorite Store:
Favorite Scent:
Favorite Candy:
Favorite Type of Food:
Favorite Restaurant:
Favorite Dessert:
Favorite TV Show:
Favorite Type of Music:
Favorite Artist/Band:
Favorite Type of Movie:
Favorite Movie:
Favorite Book/Author:
Favorite Outdoor Activity:
Favorite Holiday:
Favorite Place To Go:
Favorite Pastime/Hobbies:
When I am not at school or work I spend most of my time:
Things I would like to do together include:
I would really like to learn how to:
Something else I would like you to know about me:
Some life skills I would like to learn:
Should be Empty:

Background