Application to Send Children - Agency

Thank you for your interest in scheduling children to come to Youth Haven! We're excited about the possibility of partnering with you to better meet the needs of disadvantaged boys and girls. Working together, we know we can make a difference!

Please complete the application below. There is no charge for the children to attend our programs; sponsors pay for their stay here, so we ask that you please provide as much detail as you are able. This helps us to ensure that we are scheduling those children who could best benefit from our free programs, and allows us the ability to share with our sponsors why their financial gifts are important. (We take great care to protect the confidentiality of the children.)

Once your application is received and approved, our Children's Scheduling Coordinator, Stephanie Stanley, will be in touch with you to get the child(ren) scheduled for a time at Youth Haven. Please feel free to contact us if you have any questions, either by phone at 517-569-3328 (Michigan), 520-466-3093 (Arizona), or by e-mail at info@youthhaven.org.

Thank you for your commitment to helping disadvantaged children become successful in life!

Required Fields (*)

Name of Agency/Organization:*
Address:*
City:*
State:*
Zip:*
Name of Primary Contact:*
Job Title:
Phone:
E-mail:*
Name of Secondary Contact (i.e. Director, Supervisor):
Job Title:
Phone:
E-mail:
How did you hear about Youth Haven?:
Please provide an overview of the population your agency serves, and describe why and how you feel the children that come through your agency would benefit from Youth Haven's services:*