Lion House Youth Application (18-24 years old)
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Email *
Name (First, Last) *
Date of Birth *
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Age *
Gender *
Pronoun(s) *
Do you identify as LGBTQ+? *
Are you a Wyandotte County resident? *
Where are you living right now (house/apt, friends, relatives, shelter, hotel, street, car, other)? *
Phone Number *
Email *
Alternative means of contact (Facebook, Instagram, etc.) *
Preferred method of contact? *
Have you ever applied to this program? *
How did you hear about Lion House? *
Do you know anyone who is or has been in the Lion House program? *
What are your reasons for applying to the Lion House program? *
Have you ever been in any other independent living program? (Examples include Hillcrest, ReStart, Synergy) *
Are you currently working with a case manager? (If yes, please list name and contact number) *
Do you currently have children in your custody? *
What form of transportation do you use? *
Are you currently enrolled in school? (If yes, please list school name) *
Let us know if you have any questions about the Program, or further comments on any sections of the applications.
A copy of your responses will be emailed to the address you provided.
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