This request page is intended for Oklahoma Successful Adulthood (formerly Independent Living) Eligible youth only. If you have questions about your eligibility, please contact us at or 1-800-397-2945.

* 1. What is your client ID? (Contact your worker if you don't know what your Client ID is. If your client ID is entered incorrectly we will e-mail you back. We cannot process your funds until we have a correct client ID.)

* 2. What is your first name?

* 3. What is your last initial?

* 4. What is your date of birth?

What is your date of birth?

* 5. What is your e-mail address? (If you do not have an e-mail address create one or talk to your worker about a funds request.)

* 6. What is your phone number?

* 7. Which best describes your custody type?

* 8. Who should the check be made out to? (Who is the vendor? Check's cannot be made out to individuals without permission. Contact us at if your check needs to be made out to an individual.)

* 9. What is the address of the business (or person) we are making the check out to? (We do not make checks out to youth for purchases.)

* 10. Where would you like us to send the check? (We do not send checks to vendors. This needs to be your address or to the address of someone you trust.)

* 11. What are you going to buy? (Be specific and estimate the cost for each item/service. Be specific with size, color, number, and description.)

Example: 1 Graduation Cap- blue, 1 Graduation Gown- blue, 1 White and blue Graduation Cap tassel, etc.

* 12. How will this request support your independent living plan? (Provide an explanation as a step for your plan.)

Example: I am requesting a tutor because I want to raise my chemistry grade from a C to an A.

Example: I am requesting a pair of steel toe boots because they will support my goal to have employment as a welder.

* 13. Total cost of item requested with tax. (Please note if the item you're requesting ends up costing less than the check by more than 5% you will need to buy a money order with the change and send it back to the check writer. Items must be $25 or or more.)

* 14. I understand that this request will go to my worker for final approval.

* 15. I understand that I MUST send a copy of the receipt for the item I am purchasing to the following email address or fax number after my purchase. Email receipts to or fax receipts to 877-364-2837.
If I do not send a receipt in I will not be able to request any more funds until I have submitted the receipt or paid back the amount I requested. (Please make a copy of the receipt OR take a picture of it and saveit on your phone in case it is lost.)

* 16. I understand that my check will arrive by mail within 10 to 15 business days of my worker approving my request, NOT the date that I am submitting it.

* 17. I understand that reimbursements require prior approval.  Email reimbursement receipts to

* 18. Questions or comments. Click "Done" at the bottom of this survey to submit your request.