Inspire Network Interest Form

Who is completing this form? *

me! a young person / future network member

caseworker / ILP

another adult

Youth Name *

First Name

Last Name

Youth Phone *

(###)

###

####

Do you have a preferred way for us to reach out to you? *

Phone/Text

Email

Other (indicate below)

No preferences

What kind of events might you be interested in?

Healthy Relationships (community support, social skills, friendships, etc)

Career Preparation (career field tours, job retention tips, etc)

Employment Opportunities (internships, interviews, etc)

Financial Management (budgeting, saving, banking, etc)

Mentoring (having an adult or peer mentor supporting you)

Leadership (becoming a peer mentor, advocacy opportunities)

Other ideas (let us know when we meet)

Date of Birth *

MM

DD

YYYY

Do you have a DHS Caseworker or ILP worker? *

Yes

No

I'm not sure

DHS Child Welfare Caseworker Name

First Name

Last Name

Name of Person Completing Form (if not youth)

First Name

Last Name