Thank you for your interest in Youth Home, Inc. We are here to help your child and family through the difficult times you are experiencing.
Listed below are links to forms asking for some important information that we need.
You may mail these forms back to us at the address below or FAX them to us at (501) 821-7709. You may also mail or fax copies of any records, which you may already have, which will enable us to review your case even faster. We will keep you regularly informed as to the status of your case and welcome your calls to check in with us as often as you like.
Youth Home serves beneficiaries of all Provider-Led Arkansas Shared Savings Entities (PASSE). We also accept TRICARE and other private insurance.
If you would like further information or have any questions, please feel free to call the Admissions Department at (501) 821-5500 or 1-800-728-6452.
Thank you again for your consideration of Youth Home, Inc.
Mail or Fax Forms to:
20400 Colonel Glenn
Little Rock, AR 72210-5323
FAX: (501) 821-7709
Please download the following documents, fill out, and return to Youth Home by fax or mail at the address provided above.
Please also complete the following Electronic Authorization Forms if needed.
What to Bring
Do not bring more than the number listed below. Excess items will be sent back home.
- Underwear – 7 pair
- Shoes – 3 pairs, 1 to be Athletic shoes for Recreation and P.E.
- Shower shoes – 1 pair
- Nightgown/Pajamas – 3
- Long pants or jeans – 5
- Sweater or Jacket – 1
- Belt – 1
- Sports Bras ONLY – 4 (no underwire or other type of bra is allowed)
- Shorts – 5
- Shirts or Blouses – 7
- Sweatshirt – 2
- Winter Coat – 1
- Winter Hat – 1
Do Not Bring – Prohibited Items
- For safety and program reasons, these items are prohibited. Any item not listed may be identified as prohibited by staff at any time.
- Weapons or protective/defensive devices
- Items or clothing with Cords or Drawstrings, including hoodies, jackets, sweatshirts, sweat pants, pajamas, thong underwear, shorts or pants
- Stockings, pantyhose or tights
- Facial or ear piercing deemed a safety risk. Stud earrings and piercings are usually allowed, but hoop earrings are not
- Plastic bags
- Sharp Objects, including scissors, knives, pocket knives, metal nail files, knitting needles, sewing needles, safety or straight pins
- Metal combs, hair picks or rattail combs
- Any liquid which contains alcohol, such as Mouthwash. Any personal care or hygiene product identified as containing alcohol are not permitted (hair product, shampoo/conditioner, body lotion, deodorant or other items)
- Spray or aerosol cans
- Glass containers or other glass items
- Razors (single)
- Compacts with glass mirrors
- Manicure sets
- Coat Hangers (plastic or metal)
- Tape recorders, televisions, radios, iPod or other digital media device, cellular phones, cameras, beepers, computers, portable DVD players or any electrical appliance not required for personal daily grooming
- Steel toed boots, high heels
- Cigarette lighters or matches
- Any other item deemed hazardous by staff