Miller University's Technical Neighbor Empowerment Program
Apply to Join the next group starting August 2024. *Availability is subject to program funding & truthful answers. We are accepting applicants into our program for training individuals experiencing homelessness through our online platform on how to become independent by making money online. Your Journey Starts Here!
Name
*
First Name
Last Name
Age
*
Gender
*
Please Select
Male
Female
Non-binary
Prefer not to say
Race/Ethnicity
*
Please Select
Caucasian
African American
Hispanic
Asian
Native American
Other
Prefer not to say
Marital Status
*
Please Select
Single
Married
Divorced
Widowed
Prefer not to say
Number of Dependents?
Are you taking care of anyone that is homeless as well?
Have you participated in a Program like this before? If so, which one(s)?
*
If you participated in a Program like this before, what was the outcome? Did it help you? Why/Why not? If you did not participate before, what are you hoping to get out of this Program?
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Income Level
*
Please Select
Below $10,000
$10,000-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000 and above
Prefer not to say
Employment Status
*
Please Select
Employed
Unemployed
Retired
Student
Prefer not to say
Education Level
*
Please Select
No formal education
High school/GED
Some college
Bachelor’s degree
Graduate degree
Prefer not to say
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How did you become Homeless? Please tell us your story..
*
Which Country are you in?
*
Please Select
United States
Canada
Mexico
Brazil
Argentina
United Kingdom
France
Germany
Italy
Spain
Russia
China
India
Japan
South Korea
Australia
New Zealand
South Africa
Egypt
Nigeria
Saudi Arabia
United Arab Emirates
Turkey
Iran
Indonesia
Thailand
Vietnam
Philippines
Other
If in the United States, which State are you in?
*
Please Select
I live outside the United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
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
What is your Zip/Postal Code where you live?
*
Housing Status
*
Stably Housed: Living independently in a house or apartment or Temporarily staying with family or friends but not at risk of homelessness
In Transitional Housing: Living in a facility providing temporary living arrangements or Residing in a structured environment facilitating reintegration (e.g., for recovery or post-incarceration).
Sheltered: Staying in short-term emergency housing or Residing in a shelter providing longer-term accommodation.
Unsheltered: Living on the streets without any formal shelter, Living in cars, vans, or other vehicles or Living in tents, under bridges, or in other makeshift structures.
Housing Insecurity: At risk of losing housing but currently housed or No fixed address, frequently moving between temporary housing options.
Other
How long have you been in this Housing Status?
*
Please Select
Less than 6 months
6 months to 1 year
1-2 years
More than 2 years
Do you have Legal Issues that affect your ability to get a JOB? Please answer honestly as this does NOT exclude you from the program but may be verified.
*
Yes
No
Prefer not to say
Other
Do you have Legal Issues that affect your ability to get HOUSING? Please answer honestly as this does NOT exclude you from the program but may be verified.
*
Yes
No
Prefer not to say
Other
Are you addicted to DRUGS? (excluding Marijuana) Please answer honestly as this does NOT exclude you from the program but may be verified.
*
Yes
No
Prefer not to say
Other
Are you addicted to ALCOHOL? Please answer honestly as this does NOT exclude you from the program but may be verified.
*
Yes
No
Prefer not to say
Other
Are you in a Recovery/Rehab Program? Please answer honestly as this does NOT exclude you from the program but may be verified.
*
Yes
No
Prefer not to say
Other
How are your Family & Social Networks?
*
Strong
Moderate
Weak
Unable to Contact
Unable to Find
Do not want to contact/find
None
Do you have Previous Homelessness Experience?
*
Yes
No
Prefer not to say
Other
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Physical Health Status
*
Excellent
Good
Fair
Poor
Prefer not to say
Other
Mental Health Status
*
Excellent
Good
Fair
Poor
Prefer not to say
Other
Disability Status
*
No disability
Good
Fair
Poor
Prefer not to say
Other
Do you have access to Healthcare Services
*
Yes
No
Prefer not to say
Other
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Submit
Where do you have regular access to the internet?
*
Cell Phone
Personal Computer
Library
Friend/Family's House
I don't have regular access to the internet
Other
What is your literacy level with computers?
*
Advanced (I know how to Code or what Zapier is)
Intermediate (I know what Slack is)
Some knowledge (I know how to use Google Docs)
Beginner (I know how to Type)
None
Other
Please list your current skill sets (including technical/computer skills and manual labor)
Are you a U.S. Veteran?
*
Yes
No
Other
What is your email address?
*
example@example.com
If you have a Cell Phone, please provide your number
Please enter a valid phone number.
Format: (000) 000-0000.
What's the best way to get in contact with you?
Please upload a recent photo of yourself
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