Foster Care Transition Program Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Why Join the Program?

Transitioning out of foster care can feel like crossing unknown bridges and facing unseen barriers. At Live Well Community Services, we are committed to helping you navigate this journey. We create a supportive environment where you can thrive, learn, and grow!

How We Help You

Peer & Family Support
Job Skills & Career Development
Counseling Services
G.E.D. Classes & School Enrollment
Networking & Community

*Please complete the application below and a Live Well Community Services staff member will review it for eligibility to determine if you qualify for the program and then contact you about the next steps. This application will take approximately 5 - 10 minutes to complete.

Email *

First & Last Name: *

Current Home Address:

Phone Number: *

Birth Date: *

Last 4 numbers of your social security number:

Do you have health insurance? *

Yes

Other:

What is your AHCCCS ID number? *

Are you currently enrolled in high school, vocational school, or college? *

Yes

Other:

Are you currently employed? *

Yes

Other:

Are you a current or former foster care youth? *

Yes. I am a former foster care youth.

Yes, I am currently in foster care.

Other:

Do you have a foster care case manager? If so, what is their name and contact info (phone or email address)?

How did you hear about the Live Well Community Services Foster Care Transition Program?

I was referred by my a community or nonprofit organization

I was referred by a friend or family member

I was referred by AHCCCS

I was referred by law enforcement

I was referred by DES

I was referred by a counselor at a mental health or behavioral health facility

Internet search

Other:

Clear selection

Don't forget to press the 'Submit' button at the bottom of this application. By checking the box below, you acknowledge that you understand that this application is the first step in the eligibility process, and that a Live Well Community Services staff member will contact you with more information. *

Yes, I understand.

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms