My Path Forward ILA Application Reach Your Goals with Our Support "*" indicates required fields Step 1 of 5 20% EmailThis field is for validation purposes and should be left unchanged.My Path Forward Independent Living Arrangement is a collaboration of the Children’s Home Society of Virginia, a licensed child-placing agency, and the Better Housing Coalition, a Richmond-based nonprofit community development organization. This initiative is designed to empower at-risk youth aging out of foster care, provide them with critical social supports, and assist them as they develop into responsible, productive adults and engaged members of our communities. My Path Forward includes housing with a roommate on campus at one of BHC’s rental communities. In addition, each youth will be assessed at the outset for their most critical needs, and both program staff and partners will provide pathways to essentials such as education, transportation, employment, counseling, and life skills training. Requirements: Each program participant must be capable of living independently in a community of apartments with a roommate. Each program participant must also be capable of becoming fully independent and self-supporting upon discharge from the program. Other necessary skills include: the capacity to be engaged in their education and/or career training, to work and maintain part- or full-time employment, to learn and grow, to participate in counseling and mental health services, to observe all program rules and policies, and to comply with the youth-driven life, career, and education plans created with their case manager. Referrals: We accept referrals from organizations serving young people in or who have aged out of foster care, and from young people who have aged out of foster care. My Path Forward-ILA Eligibility Requirements To be considered for My Path Forward ILA, each applicant must: Have aged out of foster care or have prior foster care experience; Be 17-25 years old; Demonstrate the capacity to live independently while in the program; Demonstrate the capacity to become fully independent and self-supporting upon discharge from the program; Not be pregnant or be the custodial parent of a child; Have no criminal convictions reflecting acts of violence, or any other conduct or activity which establishes a pattern of violence that poses a direct threat to the health and safety of other residents; Have no criminal convictions or a pattern of behavior reflecting a pattern of crimes against property; Have no significant mental health challenges that require 24 hour a day supervision and redirection. REFERRING WORKER PRE-SCREENING:Will youth be at least 17 upon requested admission?* Yes No Does youth require around the clock supervision due to mental health and/or behavioral issues?* Yes No Is this youth on prescribed medication(s)?* Yes No Please describe the youth’s supportive relationships and include any available contact information.*Please list any health issues or mental health concerns. Youth Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Age:*Date of Birth:*Social Security #:*Email* Cell Phone:Home Phone:Gender Female Male Transgender Non-binary Other PronounsPrimary Language?*Speaks English? Yes No Is the youth currently in school (high school, college, or vocational training)? Yes No (Former) High SchoolGradeGPACollege/Vocational School# Courses CompletedDegree ProgramGPAIs the youth currently employed?* Yes No Present Living Situation* Foster Parent(s) Group Home Biological Family Couch Surfing Living with a Friend Homeless On his/her own Other Does youth have a driver's license?* Yes No Learner's Permit?* Yes No Does youth have a car?* Yes No What would be the youth's desired move-in date?* MM slash DD slash YYYY ELIGIBILITY VERIFICATION:Current DSS agency providing service to the applicant:*Start date of out-of-home placement: MM slash DD slash YYYY End date of out-of-home placement: MM slash DD slash YYYY Youth Transition Plan (File Upload):Accepted file types: doc, docx, pdf, Max. file size: 25 MB. CASE WORKER INFORMATION:Name of Current Social Worker:*County/Agency:*Phone:Email: Name of Past Social Worker(s):Please include counties/agencies, phone numbers, and email addresses for each REFERRAL INFORMATION:Person Making Referral:Phone:Email: Relationship to Youth:* Attorney Caregiver Mental Health Professional School Staff Case Worker Self Referral Other Reason for Referral:*Social Worker/Reference SignatureDate* MM slash DD slash YYYY UntitledFirst ChoiceSecond ChoiceThird Choice
