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:–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 License
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:
