OFYC Member Application:
Please fill this out if you are a youth/young adult interested in being a member of OFYC.
If you have any trouble with this application, please call Lisa or Kate at (503) 236-9754.
Legal first name:
Legal last name:
Middle:
Preferred Name:
Street address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip
Cell phone #:
xxx-xxx-xxxx
Home phone #:
xxx-xxx-xxxx
Email:
Facebook name:
School attending (If still in school):
Date of Birth (MM/DD/YYYY):
Pronouns (she, he, they):
Gender:
What is the best to follow-up with you? Please check 2 options:
Home phone
Cell phone
Email
Text message
Trusted adult
Facebook
Facebook Name:
Do you have any leadership or public speaking experience? If so, please describe:
If you could make 2 things better about your time in care, what would they be?
Why do you want to be a member of Oregon Foster Youth Connection?
The following section is optional. By collecting this data, we hope to better represent all youth in our community so that all voices are heard.
Years in foster care:
Number of foster care placements:
Which types of placements have you live in? (Check all that apply):
I have lived with biological family members
I have lived in group homes
I have lived with foster families
I have lived in a residential facility
I have lived with an adopted family
How do you describe your Race/Ethnicity?
Do any of the following describe your Race/Ethnicity? (Check all that apply):
American Indian or Alaskan Native
Asian / Pacific Islander
Black or African American
Hispanic / Latinx
Middle Eastern / North African
White / Caucasian
Do you identify as part of the LGBTQIA2-S Community?
Yes
No
Please describe (optional):
Do you identify as having a Disability (mental health, ADD, Autism, learning disability, etc.)?
Yes
No
Please describe (optional):
In case your contact information changes, or there is an emergency, please provide the name, phone #, and email for a trusted adult:
Name:
Relationship to you:
Phone #:
Email:
Need assistance with this form?