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Helping Advance and Nurture the Development of Youth
(954) 522-2911
[email protected]
About
Mission
History
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Staff
Next Gen
Financials & Reports
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Programs
LIFE Program
Life Program Referral
School-Based Programs
Education and Career Development
HANDY Book Scholarship
Best Buy Teen Tech Center
Library of Us
Events
17th Annual Scholars Breakfast
Connect Meet & Greet
Moonrise
HANDY Field Day
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News
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Wish Lists
Donate
Cryptocurrency Gifts
HANDY | Journey
What is Planned Giving?
Donor Privacy Policy
Gift Acceptance Policy
Volunteer Opportunities
Campaigns
Flood Restoration Fund
Contact
Donate
About
Mission
History
Board
Staff
Next Gen
Financials & Reports
Community Partners
Programs
LIFE Program
Life Program Referral
School-Based Programs
Education and Career Development
HANDY Book Scholarship
Best Buy Teen Tech Center
Library of Us
Events
17th Annual Scholars Breakfast
Connect Meet & Greet
Moonrise
HANDY Field Day
Homecoming
Men of Style
Program Events
Gallery
News
Support
Wish Lists
Donate
Cryptocurrency Gifts
HANDY | Journey
What is Planned Giving?
Donor Privacy Policy
Gift Acceptance Policy
Volunteer Opportunities
Campaigns
Flood Restoration Fund
Contact
Donate
Program Referral
Home
Programs
LIFE Program
Life Program Referral
PROGRAM INTEREST FORM
Date
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Name
*
First
Last
Date of Birth
*
Month
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Day
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1940
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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
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