Detroit Phoenix Center - SOAR Afterschool Enrichment Program Interest Form
Our SOAR Program provides a safe and supportive environment for teens in need after-school. When youth enroll in SOAR, they have access to food, washer/dryer, computers, hygiene kits, transportation assistance, recreational activities, educational and life skills, Tuesday- Thursday from 4-8. We also have optional member only programming Friday evenings and referrals with program partners for mental health services.

This form will be used as a membership referral for youth who may qualify for SOAR. All information is confidential!
Email address *
Student Name
Your answer
Student Organization/ School *
Your answer
Email
Your answer
Why are you referring this student? (If student referral - please note) *
Your answer
Parent/Guardian Name (if applicable)
Your answer
Address (if applicable)
Your answer
Phone Number
Your answer
Email
Your answer
Participant Age *
Required
Reason for Referral
If the student is seeking Afterschool Enrichment, which enrichment activities?
Any other information that we should know?
Your answer
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