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
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?*
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
Optional

Young Adult Services Enrolling Now – Ages 16-24