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Young Adult Services Enrolling Now – Ages 16-24
Name
*
First
Last
Date of Birth
*
Month
Day
Year
Which location are you interested in?
*
Southwest Detroit (Michigan Ave)
East side Detroit (Conner Street)
Email
*
Phone
*
Alternative phone number(s), Instagram Handle, or texting-only number
Please let us know the best way to get in touch with you. TikTok, postcards, iCloud numbers without a data plan, TextNow, or even WhatsApp
What is your address?
*
Contact Preference
Call me
Email me
Text me
No preference
How would you like us to contact you to tell you more about our services and setting up your appointment?
Does at least ONE of the following qualifications apply to you?
*
No
Yes
Yes, disabled or homeless veteran
Detroiter aged 16-24 | | Dropped out of Highschool | English is a second language | Veteran or served in the Military | Current or former foster | Parenting or pregnant | Has IEP / Exceptional Student / Disability | In Justice system | Housing insecure or runaway | Family or you receives food, cash, bridge card, or SSI/SSDI | Need a Job | Low Income
How did you hear about us?
*
Web search
Facebook
Twitter
Instagram
Linkedin
Google Form
Radio
Flyer
Email Blast / Newsletter
Referral-Friend/Relative
Recruitment Event/Fair
Comments
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