Apply to Our Programs

If you are an unhoused transition-age youth between the ages of 18 and 25 and you want to participate in one of our programs, please complete the application below. Fill in the fields to the best of your ability and provide as much information as possible so that we can best evaluate your needs and how our programs can help you. When you are sure that you have completed the form thoroughly, press Submit. We will contact you during normal business hours.

Your Personal Information

Legal Name(Required)
Preferred Name
If different than legal name.
Select date MM slash DD slash YYYY
Your Email Address(Required)
Preferred Language(Required)

Do you require translation services?(Required)
Do you have a cellular phone with active service?(Required)
Have you previously enrolled in an Urban Street Angels program?(Required)
Gender Identity (Optional)

Minimum Qualifications

Are you between 18 and 25 years of age?(Required)
Are you either currently homeless, living at a temporary shelter/institution, or at risk of becoming homeless (for example: "couch surfing," living in a car, or living in a place not ordinarily used as a sleeping area?)(Required)
Have you been told by a health professional that you have a mental, emotional or behavioral disorder such as schizophrenia, bipolar disorder or major depression that prevents you from pursuing your basic life activities and goals? If not professionally diagnosed, do you feel like you have a mental, emotional or behavioral disorder?(Required)
In the past 3 years, have you used urgent/emergency care services, crisis treatment facilities, been hospitalized or been incarcerated?(Required)
When, if ever, have you received mental health treatment or substance use services? (Check all that apply)(Required)
Who completed this form?(Required)