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About
Board of Directors
Annual Report/Financials
How We Help
Leadership
Youth Shelters
Youth Shelter Referral Form
Bed Availability
Brittany's Place
>
Transitional Living Program(TLP)
>
TLP Application
Community-Based Services
>
Parent Support Program - Application
Hope House
St. Cloud Youth Shelter
>
St. Cloud Advisory Board
Southeast Youth Shelter
Foster Care
Community Re-Entry
Safe Harbor
Safe Harbor Navigator: East Metro
Outreach & Supportive Services
Housing & Supportive Services
Events
Jobs
Employment
Volunteer
Donate
In-Kind Donations
NEWS
The Turnaround Newsletter
CrossCurrents 180 Degrees Blog
Press Releases
Contact Us
Brittany's Place transitional living program (tlp) application
*
Indicates required field
Date
*
Your Name
*
First
Last
Date of Birth
*
Gender
*
Female / Girl
Male / Boy
Trans-Female / Girl
Trans-Male / Boy
Gender Variant / Non-Conforming
Do Not Want to Share
Other (please specify)
Other (Please Specify)
*
Sexual Orientation / Gender Identity
*
Straight (Not Gay or Lesbian)
Lesbian or Gay
Bisexual
Two-Spirit
Do Not Want to Share
Other
Primary Spoken Language
*
English
Spanish
Hmong
Other
Do Not Want to Share
Primary Written Language
*
English
Spanish
Hmong
Other
Do Not Want to Share
Race
*
Other (Please Specify)
Asian
Black / African American
North African / Middle Eastern
Hispanic / Latino/a
Native American / Alaska Native
Native Hawaiian / Other Pacific Islander
White / Caucasian
Do Not Want to Share
Other (Please Specify)
*
Phone Number
*
Email
*
Preferred method of communication
*
Phone
Email
No preference
All potential residents must meet these qualifications (check all that apply):
*
Between 16-20 years old
Be female or female-identifying (not male-identifying)
Willing to meet with Case Manager weekly and work toward defined goals
Willing to check-in with staff and allow them to visit their room 3x per week
Willing to respond to staff as soon as possible within 24 hours if/when staff reach out to them
Willing to attend monthly house meetings
Willing to live in a community setting, seek to get along with others, honor the shared living space and take responsibility that comes with TLP
Willingness to work toward independent living/independence
Willing to be employed and/or go to school
Willing to develop a financial plan and work toward a livable income
What is your current living situation/address:
*
When do you expect to move into the Transitional Living Program?
*
My monthly income Please describe sources of income.
*
I am (select all that apply):
*
Employed, full-time
Employed, part-time
Not employed, and looking for a job
Not employed, and not currently looking for a job
What is your current school situation (check all that apply):
*
Attending school
Dropped out of school
High school diploma or GED received
Attending post-secondary school
Other
If other, please specify:
*
Do you currently have any substance abuse issues? If so, what are you doing to manage it? Are you currently taking any medications for mental health? If so, how are you managing it?
*
What qualities/strengths do you possess that will help you be successful?
*
What makes Brittany's Place Transitional Living Program a good option for you? Please tell us anything you want to share, or would like to know about Brittany's Place.
*
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