Getting Ahead Registration Form

Family Size
# of adults*
# of children*
List name (First & Last), and DOB of every adult in household besides applicant.
List name (First & Last), DOB, and school (with grade) of every child in household.
Housing Information
Do you rent, own, or live with family?

RentOwnLive with familyOther

Education
Highest grade completed:*

Grade 8 or lessHigh school (incomplete)High school/GEDSome college, vocation, or techCollege
Currently enrolled in education program?*

YesNo

How did you hear about Getting Ahead?
I certify that the following are true (check):*

I am not in a major crisis (untreated mental illness or drug/alcohol addiction, domestic violence situation, homeless); I am fairly stable. (You can discuss this further in the interview)I am willing to commit to a 16-18 week course. (Approx. three hours one night per week, childcare and dinner provided)
We will be serving a meal. If you have any food allergies, it is your responsibility to ask about ingredients. We are not responsible for any allergy or medical reaction you may have.

Information provided on this form will be used to determine eligibility for the Bridges Out of Poverty initiative and track progress toward goals.
Signature*

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Date

MonthDayYear
Date
This is an application for the Getting Ahead training; it does not guarantee you will be accepted. You will be contacted for an interview approximately one month prior to the next class starting. If your contact number changes after you have submitted this application, you are responsible for informing staff as soon as possible.

Thank you!

With any questions, please contact Sister Roberta Treppa: rtreppa@setoncenter.org
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Family Size