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Our Stories
Why Treehouse
Foster Care Facts
Financials
Our Team
Our Services
Essentials & Experiences
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Make a Referral
EFC Extension Payments
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Give
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Learner's Permit
Instructional/ Learner's Permit
DA - Reimbursement Request for Learner's Permit
Driver's Assistance Request for Washington State I.D. Card Please allow at least 3 weeks of processing time when submitting requests. Verification of program eligibility must be granted before funding can be achieved.
Your Relationship to Driver:
*
(Select the option that best describes your relationship with the participant.)
Self Request (Youth/Driver)
Caregiver, Guardian or Parent
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
Middle
Last
Participant's License Number:
*
(This is the driver's Washington State DOL PIC or WDL number found on the Identification card.)
Participant's Date of Birth:
*
MM slash DD slash YYYY
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:
*
(Where is the participant living?)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Does the driver 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:
Confederated Tribes of the Chehalis Reservation
Confederated Tribes of the Colville Reservation
Confederated Tribes and Bands of the Yakama Nation
Cowlitz Indian Tribe
Hoh Indian Tribe
Jamestown S’Klallam Tribe
Kalispel Indian Community of the Kalispel Reservation
Lower Elwha Tribal Community
Lummi Tribe of the Lummi Reservation
Makah Indian Tribe of the Makah Indian Reservation
Muckleshoot Indian Tribe
Nisqually Indian Tribe
Nooksack Indian Tribe of Washington
Port Gamble S'Klallam Tribe
Puyallup Tribe of the Puyallup Reservation
Quileute Tribe of the Quileute Reservation
Quinault Indian Nation
Samish Indian Nation
Sauk-Suiattle Indian Tribe of Washington
Shoalwater Bay IndianTribe of the Shoalwater Bay Indian Reservation
Skokomish Indian Tribe
Snoqualmie Indian Tribe
Spokane Tribe of the Spokane Reservation
Squaxin Island Tribe of the Squaxin Island Reservation
Stillaguamish Tribe of Indians of Washington
Suquamish Indian Tribe of the Port Madison Reservation
Swinomish Indian Tribal Community
Tulalip Tribes of Washington
Upper Skagit Indian Tribe of Washington
Participant's Social Worker:
*
First
Last
Social Worker Email:
*
Social Worker 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:
Catholic Charities
Volunteer of America
Olive Crest
YMCA
YWCA
Ignite
YouthNet NW
Pioneer Human Services
Pierce County Alliance
Name of Case Manager:
*
First
Last
Case Manager's Email:
*
Case Manager's Phone:
Caregiver's Name:
First
Last
Caregiver Email:
Caregiver Phone:
Caregiver's Address:
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Total Amount Paid:
*
We are currently providing reimbursements only for learner's permits.
Upload Receipt:
*
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
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.
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 will Treehouse need to write a check to?
First
Last
Mailing Address:
*
Where should Treehouse send this check?
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
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!
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