RISE Application

First Name

Last Name

Gender Identity

Date of Birth

Current Age

Phone Number

Email Address

Preferred Method of Communication

What is your current living situation?

Do you currently have stable housing?

How long do you expect your current housing to last and why do you have to leave your housing (for example: aging out of an independent living program)?

Current Address

Address Line 2

City

State

Zip Code

Did you have an open case with the Division of Child Protection & Permanency at the age of 18 (also referred to as DCP&P, DCF, or DYFS)?

Do you currently have an open case with DCP&P?

Why do you want to join the Roots & Wings RISE Program?

If you were accepted into RISE Program, what would you like to work on and/or achieve?

Where do you see yourself in five years?

What are some activities, hobbies, sports you enjoy?

Are you currently employed?

If employed, where?

Are you currently in school?

If in school, where?

How do you get around? (i.e. Uber/Lyft, own car, public transportation)

Have you been in an independent living program? If so, how was your experience?

By clicking here, I am authorizing a Roots & Wings member to contact you via phone and/or the email address provided above.

RISE Application

The Giving Tree

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