Treehouse - Request for Driver's Education

Your Relationship to Driver:*

(Select the option that best describes your relationship with the participant.)

Self Request (Youth/Driver)
Caregiver
Social Worker
Tribal Case Manager
Independent Living Specialist / Case Manager
Treehouse Education Specialist
Treehouse Launch Success Coach
Treehouse Advocate

Your Name:*

(Who is filling out this form?)

First Last

Your Email:*

(Please enter your email so that we can provide you with updates about your request.)

Participant's Name:*

(Who needs payment assistance?)

First Last

Participant's Date of Birth:*

Participant's Phone:*

(If the participant does not have a personal phone, please input the number for the person who will have the most contact with them.)

Participant's Email:*

(Must be participant's unique email address.)

Participant's Address:*

(What is the driver's current address?)

Street Address Address Line 2 City State ZIP Code

Does the youth currently qualify as one of the following?:*

(Participants must meet one of the following criteria to be eligible for Treehouse's Driver's Assistance program.)

Foster Care - Washington State Dependent
Foster Care - In-home Trial Return
Extended Foster Care - Foster to 21
Tribal Jurisdiction - Indian Child Welfare (ICW)

Participant's Tribal Association:

Participant's Social Worker:*

First Last

Social Worker's Email:*

Social Worker's Phone:

Participant's Tribal Contact:*

First Last

Tribal Contact Email:*

Tribal Contact Phone:*

Is the driver currently working with an Independent Living Specialist?:*

Yes
No

Organization associated with Independent Living Specialist:

Name of Case Manager:*

First Last

Case Manager Email:*

Case Manager Phone:

Caregiver's Name:

First Last

Caregiver Phone:

Caregiver Email:

Caregiver's Address:

Street Address Address Line 2 City State ZIP Code

Is the driver currently enrolled at a driving school?:*

If you have not enrolled and registered for driver’s education courses yet please be sure to sign up with an approved DOL driving school of your choice. Contact the driving school you’d like to attend and ask them to send an invoice to Treehouse’s Driver’s assistance program: licensing@treehouseforkids.org

Yes
No
Not Yet (waiting for Treehouse's funding approval)

Driver's Education Service Needed:*

At this time Treehouse's Driver's Assistance program can provide up to $750 (per request) for the Driver's Education related services listed below. For more information please email us.

Driver's Ed Courses
Driver's Ed Down Payment/ Reservation Fee
Practice Sessions
Testing
Re-Testing
Missed Drive/ Cancellation Fee

What is the estimated start date for the Driver's Education Course?:

(Youth must be actively enrolled or have attempted to enroll in courses with the driving school listed on the request form)

What is the estimated end date for the Driver's Education Course?:

Are you seeking reimbursement for the requested service?:*

Yes
No

Would you like your reimbursement by check or PayPal?*

Check
PayPal

For PayPal reimbursement payments:*

Please enter the name, email address, phone number or handle associated with the PayPal account.

Pay To:*

Who should we send a check to?

Participant/ Youth
Caregiver/ Guardian
Case Manager/ Social Worker

Total Amount Paid:*

(Driver's Assistance is able to provide a maximum of $750 for reimbursement of Driver's Education courses.)

Upload Receipt(s):*

Please provide a receipt for services or items paid. Be sure this shows the date, participant name, total amount paid, and business/vendor name.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Does the driver have a Washington State I.D.?*

Yes
No
Not Sure

Has the driver pre-applied online with the Dept. of Licensing for a state I.D.?*

Yes
No
Not Sure

Does the driver have a current/valid Learner's Permit?*

Yes
No
Not Sure

Has the driver pre-applied online with the Dept. of Licensing for a learner's permit?*

(Driver's must have a learner's permit before they can practice driving.)

Yes
No
Not Sure

Participant's License Number:

(This is the driver's Washington State DOL PIC or WDL number found on the Identification card.)

Driving School Location:*

(Participants and Care team must call the driving school and let them know Treehouse will be making a payment of up to $750, once the driver has been approved for funding.)

Name of Driving School:*

Driving School Phone:

Driving School Address:

Street Address Address Line 2 City State ZIP Code

Treehouse can provide limited financial assistance for the cost of travel to and from the driving school. Are you intersted in travel assistance?

Yes
No

Treehouse Driver's Assistance Release of Information*

Driver’s Assistance is pleased to provide financial support for your driving goals. In order to successfully process payments and as a condition of enrollment, Treehouse requests permission to communicate, request, and exchange documents and details from/with your driving school during enrollment in the program. Please review and ensure that all the information entered above is correct.

I understand that Treehouse is only accessing information for the purpose of making payments and any data collected will be used solely for Treehouse's Driver’s Assistance Program.
I accept and agree to all of the above and that I have reviewed the information entered above and certify that all the above is correct.

We would love to hear from you!

Please indicate below if you are willing to receive one to two surveys over the next 6 to 12 months. Your participation helps us understand how we can better support youth experiencing foster care.

Yes, send me the surveys!

Driver's Education

Request for Driver's Education

DA Request for Driver's Education