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Emergency Contact
Provide name, address, and phone numbers of a family member or a friend (not living with you) who will always know how to contact you.
Name*
First Last
Relationship*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code

Personal Questions
Have you ever been in foster care or aged-out of the system? Please explain.*
Currently Employed?*
- Yes
- No
If yes, please answer the following questions:*
Where? Currently Weekly Wage Length of Employment Contact Phone Number Hours Worked a Week
Do you have a resume?*
- Yes
- No
If yes, please upload a copy of your resume*
Max. file size: 18 MB.
Currently Attending School?*
- Yes
- No
Current School Name*
Current Grade*
Highest Level of Education (GED)?*
Have you ever applied for Federal Financial Aid?*
- Yes
- No
Currently have reliable transportation?*
- Car
- Bike
Do you have a valid Driver's License?
- Yes
- No
If yes, please submit the ID number*
Do you have a valid state ID?
- Yes
- No
Have you been convicted of a felony or misdemeanor?*
- Yes
- No
If yes, please explain in detail your charge:*
Are you currently on probation?*
- Yes
- No
If yes, what are your charges?*
Please answer:*
Who is your P.O.? How long are you on probation?
Do you currently have a case worker from the Department of Health and Welfare?*
- Yes
- No
If yes, please list the name and phone number*
Name Phone

How did you hear about the Twin Falls Optimist Youth House? Why would you like to live here?*
Please describe in detail where you see yourself in a year from now? (Career goals and educational plans)*
How do you deal with conflict or a disagreement with an individual?*
What are your education/employment goals as an adult?*
Please write a brief description about yourself (things going on in your life, family upbringing and background, interests, and hobbies.)*

The information provided on this application is true and correct to the best of my knowledge.
Applicant's Full Name*
Signature*
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Date
MM slash DD slash YYYY

208.404.3059

Who is your P.O.?	How long are you on probation?