Complete Your Application Below Let’s begin your journey to independence together. Apply now and take the first step toward a brighter future. * Indicates required form fields.Application TypeApplication Type:(Required)* Select Your Application Type:Youth Experiencing Foster CareYouth Experiencing HomelessnessHiddenYouth Experiencing Foster Care HiddenYouth Experiencing Homelessness Background InformationLicense Background(Required)* License Background--None--I am at least 16 years old and have a FL Intermediate LicenseI am at least 15 years old and have a FL Learner's LicenseI am at least 15 years old and DO NOT have a FL Learner's LicenseYouth First Name(Required) Youth Last Name(Required) Youth Date of Birth 2.0 (mm/dd/yyyy)(Required) Youth Phone(Required)Youth Email(Required) The youth is required to have a personal email address for the 4-hour course and permit test assignment.Gender(Required)* GenderFemaleMaleRace(Required)* RaceAsianUnknownBlackWhiteUnable to determineCaregiver InformationCaregiver's Name(Required) Caregiver Email(Required) Caregiver Home Phone(Required)Caregiver Mobile Phone(Required)Referral InformationFirst Name(Required) Last Name(Required) Phone(Required)Email(Required) Case Manager InformationCase Manager's First Name(Required) Case Manager's Last Name(Required) Case Manager Phone(Required)Case Manager Email(Required) *Please ensure the youth date of birth entered is correct. Failure to provide an accurate youth date of birth will result in the dismisal of the application.
