Youth

Safety Net Inland NW is a grassroots, community funded organization that raises money to help youth that have aged out of foster care and or youth in need from our community.

*Youth Name

*Youth Date of Birth

*Advocates Email

*Please tell us about your time in foster care.

*Tell us a little about yourself and what are you doing now.

*What are you requesting?

*What would this help mean to you? Your testimony will allow us to continue to aid others.

*By checking this box, signing and submitting this document, you are agreeing to allow SafetyNet InlandNW to obtain information from third party organizations pertaining to this request. Volunteers of America, Catholic Charities, Lutheran Services, Department of Children's Welfare Services, Treehouse Etc.

Yes

*Are you requesting access to shop the warehouse? SafetyNet does not currently offer delivery. Advocates and youth are responsible for transportation of any and all items from the warehouse.

Yes

*Has the youth received help from Safety Net before?

Yes

*Date

*Signature