Thrive Membership Application 2025
Please select the membership level you are interested in:
*
INTRO (Limited Benefits)
CONNECT (Social Benefits)
ENRICH (Social & Services Benefits)
Legal Name
*
First Name
Last Name
Preferred name/nickname
Pronouns
Address
*
Street Address
Township (if applicable)
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
Birthdate
*
-
Month
-
Day
Year
Date
Preferred method of contact
Please Select
Phone
Text
Email
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Emergency Information
Emergency Contact's Name
*
First Name
Last Name
Relationship
*
Contact's Phone Number
*
Please enter a valid phone number.
Contact's Email
example@example.com
Please list any medical conditions or special accommodations emergency personnel should be aware of:
Additional Information
Employed?
*
Please Select
Full-time
Part-time
Retired
Disability/IU
Seeking Job
What is/was your primary profession or employer?
*
What are your skills and interest?
Are you currently involved in any local clubs or civic groups?
Which of the following Community Thread communications would you like to receive if you don't already? (check all that apply)
*
bi-monthly printed newsletter with news and activity calendar (mailed)
monthly e-news with special events and volunteer opportunities (emailed)
None of the above
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Household and Demographic information
This information helps us comply with grant requirements and seek new funds to sustain and improve Thrive. Information will be kept confidential and used only to report statistics.
Gender
*
Please Select
Male
Female
Non-Binary
Prefer not to answer
Marital Status
*
Please Select
Married
Partnership
Single
Widowed
Divorced
Are you a Veteran?
*
Please Select
Yes
No
Prefer not to answer
Is/Was your spouse, parent or child a Veteran?
*
Please Select
Yes
No
Prefer not to answer
Education/Degree Level:
*
Please Select
High School/GED
College
Graduate
Doctorate
Prefer not to answer
Language
*
Please Select
English
Other
Prefer not to answer
If other, please specify
Ethnicity
*
Please Select
Asian
American Indian or Alaskan Native
Black/African American
Hispanic/Latino/Spanish
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White/Caucasian
Other
Prefer not to answer
If other, please specify
Household type
*
Please Select
Apartment
Townhome/Duplex
Single Home
Prefer not to answer
How many adults in your household?:
*
One
Two
Three or more
My income for a household of 1 is:
*
At or below $18,825 ($1,569/month)
Between $18,826 - $ 37,650 ($1,570 - $3,138/month)
At or above $37,651 ($3,139/month)
Prefer not to answer
My income for a household of 2 or more is:
*
At or below $25,550 ($2,129/month)
Between $25,551 - $51,100 ($2,130 - $4,258/month)
At or above $51,101 ($4,259/month)
Prefer not to answer
Is another member of your household applying for a Thrive membership OR already a Thrive member?
*
Yes
No
If yes, what is their name?
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Supplemental Application
Please complete the following if you are applying for transportation and home help services (Enrich membership).
Transportation Information
Please note, our volunteers cannot bear your weight while walking or getting in or out of a vehicle. To ensure our volunteers are fully informed, please answer the following questions.
Do you have a case worker with Washington County Community Services?
*
Yes
No
Are you able walk without the aid of a person or wheelchair
*
Yes
No
Do you use any medical equipment that a driver may need to carry in their vehicle?
*
Please Select
Cane
Walker
Oxygen tank
Other
N/A
If other, please specify:
Are there any types of vehicles that you have trouble getting into or out of?(Check all that apply)
*
Vehicle you have to step up to get into (trucks and large SUVs)
Vehicles you have to step down or sit low in (average car)
Other concern
None
If other, please specify:
Are there any unique details about traveling to or from your home that a volunteer should be aware of?
At Home Services
To ensure our volunteers are prepared to visit your home for any future task, please answer the following questions:
Do you have any pets in your home?
Yes
No
If yes, what type(s) and how many?
Is there smoking in the home?
Yes
No
Homeowner’s or Renter’s Insurance Information
To receive home services, your dwelling/property must be covered by insurance for the protection of our volunteers.
Name of your insurance company:
Policy number:
Dates of coverage:
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Thank you for completing your Thrive Membership application.
Please click submit. A member of our Thrive team will be contacting you to review your application and go over the next steps.
Submit
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