Successful Transitions (ST) Application

Application Deadline is March 26, 2022. Classes start on April 06, 2021.

After your “Completed” application is received:

An “Application Acknowledgement” letter will be sent via email notifying you that we received your application and if you have been accepted into the program. The letter will include the full course schedule with dates, times and location for all classes, as well as instructions for how to access the provisions that we have available such as: Childcare and Transportation support. Contact persons: Dewana Little: 828-747-6097 dlittle@ymiculturalcenter.org or Kelsey Simmons: 828-257-4540, kelsey@ymiculturalcenter.org

1. The Application Acknowledgement letter will include a copy of our Education History, Work History and Financial History forms; please fill them out and bring the completed forms with you to orientation.
2. Please bring the following to the orientation:Identification Card (ID) or Driver’s License (DL)

If accepted as a Successful Transitions participant your signature below certifies that it is mutually understood that:

1. Setting up/establishing a savings account is required prior to the first class.

2. Monthly savings is required. You must deposit a minimum of $20 into your savings account monthly.

3. Emergencies: If you have to withdraw some of your savings at any point during the program, which is okay. You must still make your monthly deposit and notify the program coordinator.

4. The Match: The match for savings is limited to a $500 maximum but we will match savings less than $500. It’s up to the participant to whether they meet the maximum savings goal. ($83.34 x 6 months = $500.04). To get the match a minimum of $20.00 per month must be put into your savings account and a monthly reciept of deposit must be provided to the program coordinator.

5. Participation and Absences:

a. If a participant cannot attend a class Session, you must give 24 hours notice. If it’s a last minute issue, participants must call or send an email prior to the start of class to inform the contact person and schedule a make-up class.

b. If a participant is going to be late they must call the contact person prior to class. If a participant is more than 30 minutes late, they are required to attend a make-up session.

c. Attendance to 90%, 10 classes is required. It is the participants’ responsibility to be on time.

For in-person meetings: Dinner (optional) is served from 6:00pm to 6:30pm, Programming (required) is from 6:30pm to 8:00pm.

d. 3 Make-up sessions will be offered. It is the responsibility of the participant to get signed up for these sessions, if needed. To sign-up for the classes the participant must email or call the contact person with the information on which session to sign up for.

Meeting Structure:

The meeting structure for this program will be a combination of Virtual and In-person meetings. We will alternate between the two meeting formats. For all In-person meetings, we will offer childcare, transportation, and dinner. Safety First, so we will also adhere to all public health standards to include social distancing and face mask (we will have face mask available if needed).

Successful Transitions is a six (6) month program (12 bi-weekly courses (twice a month, every 2 weeks)) where participants will learn how to manage their household expenses without the dependency on supportive services, such as Food Stamps, Medicaid, etc., and they will learn about resources and services that cover the gaps to help participants become self-sufficient. This program will help participants develop attributes linked to employability, personal development and the motivation to continue to learn throughout their professional and personal lives. Content will be delivered in presentation style format, will be a mixture of online and in-person workshops. Proficiency is measured in this curriculum through the completion of a “Personal Development Plan (PDP)” and savings requirements including a Budget, Credit Report, Cover letter and resume, list of references, and Banking Information.

Applicant's Name*

First NameLast Name

Street Address:*

City*

State*

Zip Code*

Mailing Address (if different):*

Best ways to reach you? Phone or Email:*

Phone Number*

ex: 828-xxx-xxxx

Texting OK?*

YesNo

Alternate phone (or friend/family who will take a message):*

E mail address:*

example@example.com

Do you or your kids have any food allergies? Please detail below

Do you needed childcare for in-person meetings? If so, Please tell us how many kids and their ages.*

Do you have access to a computer and the internet?*

YesNoOther

Please list the following for each member of your household: Name, Relationship to you, Social Security Number, Age, Race, Gender, Highest grade completed, and Marital Status. *

Does any family member in your home receive any of the following? Yes or No

Section 8 Housing Vouchers*

Child Care Vouchers*

Self Employment Income*

Utility Allowance*

Child Support*

Grants/ Scholarships/ Financial Aid*

Food Stamps*

Work First Benefits*

Medicaid/ Medicare*

Social Security (SSA)*

Social Security (SSI)*

Retirement/ Pension*

Please list all income and the source for all family members of your household: Household member name, Income source / Employer, and Monthly Gross Amount *

Total "Monthly" Household Income:*

What are you currently doing to find employment? What are your employment goals?*

What support systems do you have in place? This could be other organizations, friends, or family.*

Where did you hear about the Successful Transitions Program?*

How would your household benefit from the services that we provide?*

I certify that all information provided herein is true to the best of my knowledge. I am aware that this information is subject to review and verification and that I may have to provide documentation to support it. I am aware that I may be denied assistance if I am found ineligible. I understand I have the right to appeal any denial of service or assistance for which I may be eligible. I allow release of information contained herein for the purpose of verification of my situation.

Participant Signature / Full Name

Applicant's Signature*

Date*

MonthDayYear

1. I authorize the following agencies to release the confidential information chosen in #3

STEP Career Resource Center Women Song 'New Start' Program*

Asheville Housing Authority*

Buncombe County Dept of Social Services*

Self Help Credit Union*

OnTrack Financial Education & Counseling*

2. I authorize the following agencies/ individuals to receive the confidential information chosen in #3.

Asheville Housing Authority, Family Self Sufficiency program (FSS)*

Community Action Opportunities Lifeworks*

STEP Career Resource Center Women Song 'New Start' Program'*

Buncombe County Dept. of Social Services*

OnTrack Financia Education & Counseling*

3. I authorize the following type(s) of confidential information to be released.

Eligibility for Services*

Attendance Information*

Identification (DOB, Name, Address, Phone)*

Services received / Program enrollment*

4. Purposes for which confidential information may be released and used.

Case management/ coordination of services*

Referral for services*

To determine eligibility for services*

5. Person (s) about whom confidential information may be released:

Name:*

Date of Birth:*

MonthDayYear

6. This authorization may be revoked at any time and wil expire automatically on, Date:*

MonthDayYear

Confidential information is protected by state and federal laws and regulations. I understand that my consent is voluntary and that I may withdraw it any time. I understand what information about me is to be released or obtained and why such information is needed. I understand that if other specific information is needed or information needs to be released by an entity not listed above, I will be contacted and asked to sign another consent form. I have read this authorization form, or it has been read to me, and I understand its meaning.

Participant Signature/ Full Name

Signature of Client / Participant:*

Date:*

MonthDayYear

I, the Participant/Applicant named below, grant permission to Successful Transitions / Self-Help Credit Union and its program partnering agencies and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or in any manner or in any medium. I hereby release Successful Transitions / Self-Help Credit Union and its legal representatives from all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements given during interviews or program sessions, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation. I acknowledge that I am:*

[ ] over the age of 18[ ] the legal guardian of the following:

If legal guardian of participant(s), please list participant's name(s) here:

Name of legal guardian

First NameLast Name

Name of Participant / Applicant's (over the age of 18) *

First NameLast Name

Signature of participant / Applicant:*

Date:*

MonthDayYear

Signature of Guardian:

Address:*

Successful Transitions (ST) Application

Successful Transitions Program Application

RELEASE OF INFORMATION INFORMED CONSENT

Photo/Video Release Form