TO QUALIFY FOR JIT SERVICES: You must be: 1) an emancipated foster youth, 2) age 18-26, and 3) currently employed and/or enrolled in school. (If you are under 18 or have not been emancipated, you may apply 90 days before you emancipate. If you are working toward school enrollment or actively looking for a job, contact a JIT staff member before submitting an application.

*College Bound Applicants: If you are applying for College Bound Annual Event, continue filling out this application only if you will be emancipated or 18 years of age by the time of your first semester of college.

APPLICATION DIRECTIONS: You must COMPLETE ALL QUESTIONS of this application except as indicated in the school and employment sections. You will hear from JIT within 3-5 business days.

Contact Information

Baseline Information

1. Are you a former foster youth? --Choose One-- Yes No, I am a current foster youth No, I have never been in foster care

2. How many total years combined were you in foster care? --Choose One-- less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20+ years

3. How many placements did you experience while you were in foster care? --Choose One-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+

4. How did you hear about JIT? --Choose One-- Family/Friend Internet Search Facebook/Twitter ILS or Agency Case Manager JIT Presentation College Advisor TV/Radio/Newspaper

5. Date of Birth (Example: 01/11/92):

6. Gender: --Choose One-- Male Female

7. Ethnicity (please check one): --Choose One-- Black/African American Hispanic/Latino/Spanish Native American Asian/Pacific Islander White/Caucasian Multiracial Other (not listed)

8. How many children do you have? --Choose One-- None One Two or more

9. What is your source of healthcare care at this time? Check all that apply. (Ctrl+Click to select more than one)
College Health Services Medi-cal/Medicaid Employee health care plan Short-term individual plan (i.e. Cobra) Annual/Long-term individual plan Military health care plan Parents' health care plan none use preventive care clinics. none any form of health care.

10. What agencies have you received assistance from since leaving foster care? Check all that apply.
Assistance Adoption Programs Casey Family Services Cash Aid WIC/Food Stamps HOME HHSA (Health Human) Providence Community Center Regional Center SDYS SD Youth Services SPA San Pasqual Academy SBCS South Bay Comm. Services Second Chance Social Security Insurance TLP Transitional Living Program THP Transition Housing Program Trace Program WAY Internship Program WIA Workforce Investment Act YES Transition Network YMCA ILS Independent Living Services Kinship Services I have not received any assistance Not eligible to receive other services

11. What agency assistance are you receiving now? Check all that apply.
Assistance Adoption Programs Casey Family Services Cash Aid WIC/Food Stamps HOME HHSA (Health and Human) Providence Community Center Regional Center SDYS (San Diego Youth Services) SPA (San Pasqual Academy) SBCS (South Bay Community Services) Second Chance Social Security Insurance TLP Transitional Living Program THP Transitional Housing Program Trace Program WAY (Internship Program) WIA (Workforce Investment Act) YES Transition Network YMCA ILS (Independent Living Services) Kinship Services I have not received any assistance not eligible to receive other services

Housing/School Information

1. What is your current housing situation? --Choose One-- 1) Homeless/Couch Surfing 2) Transitional Housing/Dorm less than 6 months 3) Transitional Housing/Dorm 6 months- 1 year 4) Living in Apartment/Home (with or without a roommate) less than 2 years 5) Living in Apartment/Home (with or without a roommate) more than 2 years

1. How far are you along in school? Select your highest level of education: --Choose One-- 1) No High School Diploma or GED 2) Earned High School Diploma or GED 3) At least one year of post-secondary school, but no degree 4) Completed 2 years of post-secondary school or earned vocational/trade/2-year college degree 5) Earned 4-year college degree 6) One or more years of graduate school

3. Are you currently enrolled in school? --Choose One-- Yes No

4. If you are not enrolled in school, what is the reason you are not enrolled in school this semester/quarter? Check all that apply. do not have a high school diploma/GED do not have the money to pay cant work and go to school same time do not have reliable transportation do not have a stable place to live have short-term health problems have long-term health problems pregnant or primary caregiver did not sign up/have trouble with papers do not know how to sign up

5. What type of school program are you currently attending? --Choose One-- High School/GED Certificate/Technical/Trade/Vocational School 2-year Community College 4-year University or College Graduate School/Law School

6. What is the name of your school?

7. Student Status --Choose One-- Full-Time Part-Time

8. What is your declared major/trade? --Choose One-- Agriculture Biology/Physical Science/Life Science Business/Finance/Economics Communications/Media Studies Computer Science/ Information Systems Construction/Plumbing/Electrical Cosmetology/Esthetology Criminal Justice/Law Cultural Studies/Language Education/ Child Development Engineering/Architecture English/Literature/Journalism History Mathematics Medicine/Healthcare/Pre-Med Nursing/Dentistry/Medical Assisting Music/Dance Political Science/Government Psychology/Sociology/Social Work Visual Arts/Graphic Design Welding/Machining/Auto-Mechanic Undecided

9. What year do you expect to graduate college/trade school/ 2-year certificate? --Choose One-- N/A 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

19. What is your cumulative grade point average? --Choose One-- Below 2.0 2.0-2.4 (D average) 2.5-3.0 (C average) 3.1-3.4 (B average) 3.5-4.0 (A average)

Employment/Financial Information

1. What is your current employment status? --Choose One-- 1) Unemployed no income/assets 2) Seeking a job or temporary seasonal job or other legal income 3) Employed in a semi-stable job or business venture 4) Permanent and stable job 1-year or maintaining business venture 5) Permanent and stable job more than 1-year/maintaining a business more than 1-year

2. If unemployed, what is the reason you are not employed at this time? Check all that apply.
I do not have a high school diploma/GED I am a student/enrolling in school I do not have reliable transportation I do not have a stable place to live I have short-term health problems I have long-term health problems I am pregnant or the primary caregiver Currently searching for employment I have had trouble with the law I have no job experience/never worked

3. How many hours do you work per week? --Choose One-- I am not working at this time. Less than 20 Hours 20-34 Hours 35-40 Hours More than 40 Hours

4. What is the name of your employer?

5. What is your hourly wage? --Choose One-- Less than $8.00 $8.00-$9.99 $10.00-$11.99 $12.00-$13.99 $14.00 or more

6. What is your current Financial Status? --Choose One-- 1) Frequently borrow money, no savings, no budget, cannot support myself at all 2) Sometimes borrow money, no savings, unmanageable budget, cannot support myself most of the time 3) Rarely borrow money, minimal savings, have a budget, can support myself some of the time 4) Rarely-never borrow money, save money regularly, live within a budget, can support myself most of the time 5) Never borrow money, savings of $3,000 or more, live within a budget, can support myself fully

Connections and Giving Back

1. Description of a caring adult (25+ years): Someone who listens to you when you need to talk, gives you good advice about a crisis, gives you information to help you understand a situation, believes in you and your dreams. Please select the following as it applies to you:
--Choose One-- 1) I do not have anyone in my life who fits this description 2) I have had someone in my life who fits this description for the last 6 months 3) I have had someone in my life who fits this description for the last year 4) I have had someone in my life who fits this description for the last 2 years 5) I have had someone in my life who fits this description for more than 2 years

Please indicate your relation to this caring adult: --Choose One--N/A I don't have a caring adult in my life right now. Friend Social Worker/Case Worker/Lawyer Relative JIT Person Clergy/Teacher/Coach Other

2. What is your level of community service? --Choose One-- 1) No Community Service, 0 Hours/Month 2) Minimal Community Service, 1-4 Hours/Month 3) Moderate Community Service, 5-8 Hours/Month 4) High Community Service, 8-12 Hours/Month 5) Leadership/Initiation of Community Projects, 13+ Hours/Month

3. Please indicate your perceived level of self-sufficiency. Where do you believe you are right now in your life? --Choose One-- In Crisis At Risk Stable Safe Thriving

4. Overall, how satisfied are you with your life? --Choose One-- Not at all satisfied Barely satisfied Somewhat satisfied Very satisfied Extremely satisfied

Communications Agreement

1. To effectively help our youth, Just In Time must communicate with all current/former case managers, social workers, college officials, employers, rental companies, volunteers and any other programs related to a former foster youth's request for assistance. In addition, agencies providing service at the Youth & Family Transition Center may share confidential information and records of individuals requesting service for the purpose of assisting those individuals with their transition to independence.

Do you agree to allow Just in Time to obtain any and all information related to your application for services?

2. I release JIT to communicate with the following past/present case managers, advisors, coaches, etc. (Please provide at least one, include phone number and e-mail)

3. What is the primary way you keep up with JIT news and events? --Choose One-- Just In Time web site Facebook/Twitter E-mail Just In Time Call Just In Time office Through ILS or agency case manager

4. May we use your comments for JIT promotions? --Choose One-- Yes No

REMEMBER, YOU MUST COMPLETE THE ENTIRE FORM EXCEPT WHERE SKIPPED QUESTIONS ARE INDICATED.