Paths for Success Participant Application

Participant Application
Paths for Success Foundation - 501(c)(3) - is a non-profit organization designed to assist Alabama citizens in obtaining skills, credentials, and/or certifications that lead to gainful employment. The Foundation provides opportunities by eliminating barriers that impact an individual’s ability to participate.

Applications will be reviewed by the Paths for Success Foundation Participant Screening Committee. Applicants will be notified when their applications are received and when a funding decision has been made. Monetary awards will be paid directly to the educational institution or organization.

Information collected in this form (demographics, barriers, etc.) will not be used to disqualify you from being considered for benefits/services from the Paths for Success Foundation.
Applicant Demographics
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Applicant's Age*
Employment Status

Full-TimePart-TimeNot EmployedOther
Where do you currently work?
What is your current position/job title?
What is your current hourly wage?
Demographic questions listed below are optional. These questions have no affect on your application score. This data is only used for informational purposes.
How would you best describe yourself?
What gender do you identify as?
What industry sector are you most interested in?

AviationConstructionHealthcareManufacturingInformation TechnologyTransportation/LogisticsOther
If you selected other, please explain.
Visit pathsforsuccess.com to find training programs funded in your area.

https://www.pathsforsuccess.com/get-training
What Community College are you interested in attending?*
What Community College are you interested in attending?

Bevill State Community CollegeBishop State Community CollegeCalhoun Community CollegeCentral Alabama Community CollegeChattahoochee Valley Community CollegeCoastal Alabama Community CollegeDrake State Community and Technical CollegeEnterprise State Community CollegeGadsden State Community CollegeJefferson State Community CollegeLawson State Community CollegeLurleen B Wallace Community CollegeNortheast Alabama Community CollegeNorthwest Shoals Community CollegeReid State Technical CollegeShelton State Community CollegeSnead State Community CollegeSouthern Union State Community CollegeTrenholm State Community CollegeWallace Community College-DothanWallace State Community College-HancevilleWallace State Community College-SelmaUNSURE or OPEN to Schools that offer my Program
What program at that college are you interested in?*
Are you currently enrolled in an adult education program?

YesNoUnsure
Are you currently experiencing any of the barriers to training or employment below? (Select all that apply)

Skills Training Tuition/FeesChildcareTransportation
Are you currently experiencing any of these additional barriers to training or employment? (*Definitions of terms will appear below when selected) Please, SELECT ALL THAT APPLY.

Able-Bodied Adult Without DependentsAdult with Aging DependentsBasic Skill DeficientCaregiverDislocated WorkerDisplaced Homemaker*English Language Learners/Low Levels of Literacy*Substantial Cultural Barrier*First Generation College StudentHomeless*Individual with Physical DisabilityLearning Disability/DifferenceLive in Public HousingLong-Term UnemployedLow Income*Migrant/Seasonal WorkerNo High School Diploma or GEDParent of Children Aging out of Social SecurityPreparing for Non-Traditional FieldSingle Parent/Pregnant WomanSNAP/WIC Recipient*Temporary Assistance for Needy Families (TANF) Recipient*Underemployed*UnemployedYoung Adult in or Aged Out of Foster CareOther
 SNAP, TANF, WIC is an individual currently receiving or member of a family that currently receives or in the past 6 months has received Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Women, Infants and Children (WIC) or the Supplemental Security Income (SSI) program
 Low Income is one whose total family income that does not exceed the higher of the poverty line or 70% of the Lower Living Standard Income Level.
 Homeless individual is someone lacking a fixed, regular residence.
 English Language Learner is a person who has limited ability in speaking, reading, writing or understanding the English language and also meets at least one of the following two conditions: o His or her native language is a language other than English o He or she lives in a family or community environment where a language other than English is the dominant language.
 Low level of literacy is a person who is unable to read, write and speak English; compute and solve problems at levels of proficiency necessary to function on the job, in the family of the participant, or in society. This is not the same as basic skills deficient.
 Cultural barrier is defined as if the participant perceives himself or herself as possessing attitudes, beliefs, customs or practices that influence a way of thinking, acting or working that may serve as a hindrance to employment.
 Underemployed individuals may include: Individuals employed less than full-time who are seeking full-time employment; Individuals who are employed in a position that is inadequate with respect to their skills and training; Individuals who are employed who meet the definition of a low-income individual; Individuals who are employed, but whose current job’s earnings are not sufficient compared to their previous job’s earnings from their previous employment.
 Displaced Homemaker is an individual who has been providing unpaid services to family members in the home and who: 1) has been dependent on the income of another family member but is no longer supported by that income; or 2) is the dependent spouse of a member of the Armed Forces on active duty and whose family income is significantly reduced because of deployment, a call or order to active duty, a permanent change of station, or the service-connected death or disability of the member.
Please UPLOAD SUPPORTING DOCUMENTATION to verify participation in programs selected or low income status. (SNAP, TANF, WIC approval letter, picture of EBT card or other documentation, paystub, test scores, family separation documentation, etc.)

Cancelof
Military Affiliation (upload supporting documentation below)

I am an Active Duty, currently serving Guard or Reserve member or veteran.I am the spouse or immediate family member of a military member (active, guard/reserve, veteran).
Which military branch are/were you affiliated with?

Army / Army ReserveNavy / Navy ReserveAir Force / Air Force ReserveMarines / Marine Corp ReserveCoast Guard / Coast Guard ReserveSpace ForceArmy National GuardAir National Guard
Law Enforcement / EMS Professionals (upload supporting documentation below)

I am currently serving as a law enforcement officer, an EMT/ paramedic, or a fire professional.I am the spouse or immediate family member of a currently serving law enforcement officer, an EMT / paramedic, or a fire professional.I am a retired Law Enforcement / EMS Professional
Please UPLOAD SUPPORTING DOCUMENTATION to prove Military or EMS connection. To include DD214, Military Orders, DD1172, or letter from department. (please redact any compromising information)

Cancelof
Statement of Purpose (Optional)

In the space below, the applicant has the option to write a 1-2 paragraph statement of purpose based on the criteria below:
1. From the list of barriers above, describe the barrier that is causing you the most hardship in achieving your skills training goals?
2. Why are you pursuing this training program?
3. What are your career goals?
Statement of Purpose
Attestation

I certify that the facts and statements made in this application are true to the best of my knowledge and belief.
Type your full name here to certify that the facts and statements made in this application are true to the best of your knowledge and belief.
Date Signed

MonthDayYear
Date
By signing this Scholarship Agreement, the recipient expressly agrees and acknowledges that if they do not complete the program for which this scholarship was awarded, including dropping any classes or programs, the recipient will be responsible for reimbursing Paths for Success Foundation for all scholarship funds disbursed on their behalf. Additionally, the recipient will be obligated to pay their Community College for any tuition, fees, and other expenses not covered by the Foundation’s initial scholarship payment under this Agreement. The recipient’s Community College shall be considered an intended third-party beneficiary of this Scholarship Agreement.*

I agree
Paths for Success Foundation

Bartlett Hall - 126 Church Street | Montgomery, AL 36104

www.pathsforsuccess.com | info@pathsforsuccess.com | (334) 861-2049
Should be Empty:

Participant Application

Applicant Demographics

Attestation