LAUNCH Interest Form

CII’s LAUNCH program is focused on building relationships between current and former system-involved youth (14 -27), mentors and peers. This program is intended to support your educational success, identify meaningful career opportunities, support your emotional and physical wellness and help you develop a network of support for navigating life’s journey. Fill out the form below to sign up for more information about LAUNCH!

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1. Interest Form Information (Required.)

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2. DOB (Required.)

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3. Gender (Required.)

Male

Female

Other (please specify)

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4. Contact Information (Required.)

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5. Email

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6. Address (Required.)

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7. Foster Care/Probation History (Required.)

Current Foster Care Youth

Past Foster Care Youth

Current Probation

Past Probation

Not Applicable (NA)

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8. What services are you interested in?

Please check all that apply to you and use the box below to specify the activities you enjoy.

Employment Support Services

Mentorship

Workshops and Events

Wellness Activities (gardening, drumming circle, yoga)

Recreational Activities (dancing, boxing, movie night, video games)

Art (drawing, painting, open mic)

Skills Building (resume writing, financial literacy, education support)

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9. How did you hear about us?
(Optional)

Thank You for Completing the Survey

LAUNCH Interest Form

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* 1. Interest Form Information (Required.)

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* 2. DOB (Required.)

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* 3. Gender (Required.)

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* 4. Contact Information (Required.)

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* 5. Email

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* 6. Address (Required.)

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* 7. Foster Care/Probation History (Required.)

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* 8. What services are you interested in?Please check all that apply to you and use the box below to specify the activities you enjoy.

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* 9. How did you hear about us?(Optional)

1. Interest Form Information (Required.)

2. DOB (Required.)

3. Gender (Required.)

4. Contact Information (Required.)

5. Email

6. Address (Required.)

7. Foster Care/Probation History (Required.)

8. What services are you interested in?

Please check all that apply to you and use the box below to specify the activities you enjoy.

9. How did you hear about us?
(Optional)