DONATE
Helping Advance and Nurture the Development of Youth
(954) 522-2911
info@HANDYinc.org
About
Mission
History
Board
Next Gen
Financials & Reports
Community Partners
Programs
LIFE Program
Life Program Referral
School-Based Programs
Education and Career Development
HANDY Book Scholarship
Library of Us
Best Buy Teen Tech Center
Events
Moonrise
Men of Style
Homecoming
18th Annual Scholars Breakfast
HANDY Field Day
News
Campaigns
Thanksgiving 2023
Holiday Giving Drive 2023
Dr. Shino Bay Aguilera’s Birthday
Contact
Support
Heroes Society
Wish Lists
Summer Meals
Donate
HANDY | Journey
What is Planned Giving?
Donor Privacy Policy
Gift Acceptance Policy
Donate
About
Mission
History
Board
Next Gen
Financials & Reports
Community Partners
Programs
LIFE Program
Life Program Referral
School-Based Programs
Education and Career Development
HANDY Book Scholarship
Library of Us
Best Buy Teen Tech Center
Events
Moonrise
Men of Style
Homecoming
18th Annual Scholars Breakfast
HANDY Field Day
News
Campaigns
Thanksgiving 2023
Holiday Giving Drive 2023
Dr. Shino Bay Aguilera’s Birthday
Contact
Support
Heroes Society
Wish Lists
Summer Meals
Donate
HANDY | Journey
What is Planned Giving?
Donor Privacy Policy
Gift Acceptance Policy
Donate
Program Referral
Home
Programs
LIFE Program
Life Program Referral
PROGRAM INTEREST FORM
Date
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Name
*
First
Last
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender
Identify LGBTQIA+?
Yes
No
DJJ involvement
Yes
No
Name of School
*
Grade level:
*
On track for grade promotion?
Yes
No
Employed
Yes
No
Place of employment
Phone
Email
(If under 18)
Caregiver's Name
Caregiver’s Phone
Caregiver’s Email
Number in Household
*
Teen Parent
Yes
No
Choose One: Household Arrangement
*
Relative Care
Non-Relative
With Parent
Foster Care
Displaced
Homeless
Shelter
TIL Housing
Person Referring Youth:
Referrer's Name
*
Agency
*
Referrer's Phone
*
Referrer's Email
*
CAPTCHA
Δ
