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

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 membersI have lived in group homesI have lived with foster familiesI 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 IslanderBlack or African American Hispanic / LatinxMiddle Eastern / North African White / Caucasian

Do you identify as part of the LGBTQIA2-S Community?

YesNo

Please describe (optional):

Do you identify as having a Disability (mental health, ADD, Autism, learning disability, etc.)?

YesNo

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:

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