Revised 2/23/2021

Jackson Street Youth Services’ Next Steps program is a transitional living program open to all young adults ages 18 - 24 in Linn and Benton counties, and the surrounding areas. The program includes housing, case management, and life skills-building services.

For questions that are not applicable to you, write "N/A."

For a paper copy of this form, and general information about the program, go to: http://jacksonstreet.org/services/transitional-living

Paper forms can be dropped off at or mailed to:
- Corvallis House: 555 NW Jackson Ave / PO Box 285, Corvallis, OR 97339
- Albany House: 1240 7th Ave SE / PO Box 1984, Albany, OR 97321

For help, please contact the Program Manager at Kevin.Shimomaeda@jacksonstreet.org or 541-360-8482.