HOPE Participant Enrollment Application
*AUTHORIZATION FOR SERVICE
I have been provided information on the referenced Family Support Services Program and wish to receive services. I understand that data on my child/youth/family will be collected, maintained, and entered into a secure database. The information will be utilized to track services for evaluation purposes and to ensure quality
services are being provided. I hereby authorize my child/youth/family to participate in the program.
Authorization for Service must be completed per Index Child/Youth at enrollment and annually
