A program division of EmberHope / SUPPORTIVE ADULT CONNECTION INTEREST FORM
STRIVE TRANSITIONAL LIVING PROGRAM
07/09/13
Please check ALL boxes indicating ways you would be able to be a Supportive Adult Connection for a young person in the STRIVE Program.
A HOME FOR THE HOLIDAYS
A PLACE TO DO LAUNDRY
EMERGENCY PLACE TO STAY
A MEAL WITH YOUR FAMILY OR OCCASSIONAL FOOD
CARE PACKAGES AT COLLEGE
EMPLOYMENT OPPORTUNITY
WORK REFERENCE
JOB SEARCH ASSISTANCE
CAREER COUNSELING (APPRENTICESHIPS)
HOUSINGHUNT
MENTOR
TRANSPORTATION
EDUCATIONAL ASSISTANCE
RELATIONSHIP/MARRIAGE/PARENTING MODELING
ASSISTANCE WITH SETTING UP MEDICAL APPOINTMENTS AND UNDERSTNDING DOCTORS
STORAGE
MOTIVATION
SOMEONE TO TALK TO/DISCUSS PROBLEMS
CLOTHINGa supportive adult can assist with laundry, ironing, mending, or occasionally purchasing a new item.
SPIRITUAL SUPPORT Invite the young adult to church and church activities.
LEGAL TROUBLES asupportive adult can assist by connecting Young adult to needed legal services.
A PHONE TO USE OR BE A MESSAGE PHONE
A COMPUTER TO USE
CULTURAL EXPERIENCE
APARTMENT MOVE INpacking, to manpower, a truck to move, to help setting up the new apartment.
COOKING LESSONS/MEAL PLANNING AND GROCERY SHOPPING
REGULAR CHECK IN (DAILY, WEEKLY, OR MONTHLY)
BILLS AND MONEY MANAGEMENT EXPERIENCE
DRUG AND ALCOHOL ADDICTION HELP
HELP WITH READING FORMS, DOCUMENTS, AND COMPLEX MAIL
MECHANICAL AND/OR BUILDING PROJECTS
HOUSEKEEPING
HOME DECORATING
ENCOURAGE AND ASSIST IN REGISTERING TO VOTE
ENCOURAGE TO VOLUNTEER AND INVOLVE YOUNG ADULT IN YOUR VOLUNTEERISM
FINDING COMMUNITY RESOURCES
BABYSITTING
EMERGENCY CASH
REFERENCE
ADVOCACY
Supportive adultscan help a Young adult organize their thoughts, speak on their behalf, orassist in writing letters.
INCLUSION IN SOCIAL CIRCLE/COMMUNITY ACTIVITIES
A supportive adult can extend regular invitations to the Young adult to attend social and community gatherings as an opportunity to form new friendships and makeconnections with people.
CO-SIGNER
Many times Young adult need co-signers to acquire housing, car loans, or bank accounts. Consider the financial liability if the Young adult were to miss payments or not keep the financial agreement. It is suggested that an adult who acts as a co-signer closely supervise the arrangement until the Young adult has established a consistent pattern of responsibility.
SAFETY AND PERSONAL SECURITY
The supportive adult can make suggestions regarding home safety, can help develop an evacuation plan, and make plans about what to do in an emergency situation. The supportive adult can offer to be their emergency contact person.
RECREATIONAL ACTIVITIES
Extending an invitation to a Young adult to go bike riding, go bowling, and shoot some hoops or to simply take a walk. Recreational activities like cooking, woodworking, painting or playing guitar can provide an outlet for Young adult and help to develop skills. Other activities include going to a movie, playing cards, taking photographs, going shopping or taking a short trip.
Other:CONTACT INFORMATION – PLEASE COMPLETE THE FOLLOWING SECTION:
Supportive Adult’s (your) Name:Street Address:
City, State, Zip
Phone 1: / ( ) - Type: Home Mobile Office
Phone 2: / ( ) - Type: Home Mobile Office
Email:
HOW WOULD YOU PREFER TO BE CONTACTED? MAIL PHONE 1 PHONE 2 EMAIL
Additional Adults in the home:
Name: / Relationship to Above: / Interested in being co-supporter: / Interested in supporting other youth: / Not Interested in participating: