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Pandemic Relief 2.0 Registration

Extra Pandemic Relief is here! Please answer the questions below and we will contact you as soon as possible.  ONLY REGISTER ONE TIME. BE SURE TO ENTER THE CORRECT EMAIL ADDRESS AND/OR PHONE NUMBER.

* Eligible youth include current foster youth 18 – 21;  Former foster youth 18 - 22 who were in foster care on their 18th birthday or were adopted at 16 years old or older. 

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* 1. First Name

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* 2. Last Name

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* 3. If your name legal has changed, what was your name while in state's care (first, last name)

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* 4. Date of Birth

Date

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* 5. Age

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* 6. Phone Number (xxx-xxx-xxx)

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* 7. Email address

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* 8. What is the best way to contact you? 

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* 9. What COUNTY do you live in?

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* 10. Current City

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* 11. Experience with state's care:

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* 12. Are you currently employed?

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* 13. Do you have your high school diploma or GED?

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* 14. Do you have your FULL Driver's License?

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* 15. Are you currently receiving an Education Training Voucher? 

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* 16. Have you already received the $2,000 special stimulus payment? 

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* 17. Please check all areas where you need assistance: 

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