ELIGIBILITY REQUIREMENTS

Per section 409.1454(4), Florida Statutes, eligible youth include:

1. Youth in out-of-home care;
2. Youth who have reached permanency may receive services up to 6 months after the date they reach permanency;
3. Youth in out-of-home care who turn 18 years of age may receive services up to 6 months after the date they turn 18; or
4. Youth who are continuing in care under section 39.6251, Florida Statutes
5. Youth continuing in care under section 39.6251, Florida Statutes, must demonstrate that such costs are creating barriers for obtaining employment or completing educational goals.
6. Youth must also be eligible to obtain licensure pursuant to Chapter 322 Florida Statutes.

BACKGROUND INFORMATION

License Background:

Youth First Name:

Youth Last Name:

Youth Date of Birth (mm/dd/yyyy)*:

Youth Phone (xxx-xxx-xxxx):

Youth Email:

CAREGIVER INFORMATION

Caregiver's Name:

Caregiver's Home Phone (xxx-xxx-xxxx):

Caregiver's Mobile Phone (xxx-xxx-xxxx):

Caregiver's Email:

CASE MANAGER INFORMATION

Case Manager's First Name:

Case Manager's Last Name:

Case Manager's Phone (xxx-xxx-xxxx):

Case Manager's Email:

*Please ensure the youth date of birth entered is correct. Falure to provide an accurate youth date of birth will result in the dismisal of the application.

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