Getting Ahead Class Application
Welcome!
We are so glad you are here! Congratulations on taking your first step toward a new future! This class is for people who are ready to make real changes in their lives and break free from the cycle of poverty.Because space is limited, not everyone will be able to join our Getting Ahead class. We will look carefully at every application. At least 3 weeks before class begins, we will call you to talk about your life right now and your goals for the future. After that, we will choose who will be in the June 2026 semester’s class. If you are not selected this time, don’t lose heart—more classes will be offered soon, and you will have another chance to join.
Date:
*
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Month
-
Day
Year
Date
Name:
*
First Name
Last Name
Spouse's Name:
First Name
Last Name
Date of Birth:
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Month
-
Day
Year
Date
Age:
Do you currently have stable housing?
Yes
No
What is your housing situation?
I own a home
I rent a home/apt
I live with family/friends
Other
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
*
example@example.com
Please list names of ALL adults in household:
*
Please list name(s) & age(s) of children in household:
*
Do your children live with you?
*
Yes
No
If not, where do they live?
Do you have visitation rights?
Yes
No
Are other children in household?
*
Yes
No
Will you require childcare while you are attending Getting Ahead Class each week? (We provide on-site childcare for free to our students)
Yes
No
How many children will require childcare each week?
Referral
I was referred to Compassion Center: Getting Ahead by:
Referral phone number *This person may be contacted to discuss your participation:
Please enter a valid phone number.
Format: (000) 000-0000.
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Employment
Employer's Name:
*
Job Title:
*
Length of Employment:
*
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Hope
On a scale of 1-10, what is your current level of hope that things will get better based on your current circumstances?
*
No Hope
1
2
3
4
5
6
7
8
9
Full of Hope
10
1 is No Hope, 10 is Full of Hope
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Education
What is the highest grade you've completed?
*
1st - 6th grade
7th - 8th grade
9th grade
10th grade
11th grade
12th grade
Associates Degree
BA/BS Degree
Masters Degree
Are you currently enrolled in an Education Program?
*
Yes
No
If yes, what program are you in?
Date Enrolled:
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Month
-
Day
Year
Date
Anticipated Completion Date:
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Month
-
Day
Year
Date
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Income
Please select ALL sources of income:
*
Salary/Wages
Food Stamps
SSI/SSDI
SNAP
Child Support
Unemployment
Other
Total GROSS monthly income from ALL sources? (Before taxes are taken out)
*
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Transportation
Do you have a working vehicle?
*
Yes
No
Other
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Current Service Agencies
Please check the agencies you are currently working with:
Head Star/CAP Programt
Utility Assistance Program
Food Stamps/SNAP/WIC
Free/Reduced school lunches
Medicaid
Salvation Army
Adult Education (GED)
Drug Court
Recovery Program
Probation/Parole
Other
Service Professionals
Please list name and contact information of professionals you receive ongoing services from.
Alcohol/Drug Treatment:
Counselor/Therapist:
Vocational Rehab:
Probation/Parole Services
Other:
Please select the area(s) where you are experiencing difficulties:
*
Employment
Transportation
Training/Education
Limited Reading Abiity
Budgeting
Food
Safety
Planning
Community Problems
Isolation/Lack of Social Support
Housing
Alcohol/Drugs
Mental Health
Dental/Vision
Behavior of Children
Income
Lack of Opportunity
Parenting
Legal
Healthcare Costs
Physical Health
Boundaries
Stress
Childcare
Discrimination
Other
Select the following statements that are TRUE:
*
If possible, I would like to eventually discontinue disability or social service assistance.
I am NOT in a major crisis that would prevent me from attending class every week (untreated mental illness or drug/alcohol addiction, domestic violence situation, homeless, etc.).
I give my permission for Compassion Center staff to talk to referring sources about participant's life situation, strengths and barriers.
I am willing to work with others to become more self-sufficient, i.e. decrease public assistance.
I understand that this course is designed for people truly ready to invest in their future and I may be dismissed from the class for habitual absences.
I am willing to participate in an interview with Compassion Center staff. It it my responsibility to arrange childcare during the interview.
I am willing to commit to a 16-week training course. (approx. 2 hrs, one night per week - childcare provided).
I agree to a background check knowing that the information obtained will not be used to determine acceptance into the class, but for safety of all participants.
I understand that if I have any food allergies it is my responsibility to ask about ingredients. The Compassion Center is not responsible for any allergy or medical reaction you may have.
Photo/Video Release
If you are selected as one of our participants/investigators - Do you authorize Compassion Center staff to use pictures and videos of yourself and your children for promotion and inspiration to others?
*
Yes
No
If no, please explain:
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Important Notice:
When you sign this page, you are giving permission for us to exchange information with the above people if necessary. Information will be used to determine eligibility for the Compassion Center: Getting Ahead initiative and track progress towards goals. I further understand that a background check will be taken for informational purposes but will not solely disqualify me for participation.
Please type your full name as your signature.
Date
*
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Month
-
Day
Year
Date
Probation/Parole Officer
Disclaimer:
This application is for the Compassion Center: Getting Ahead training/class; it does NOT guarantee you will be accepted. You will be contact for an interview approximately one month prior to the next class starting. If your contact information changes after you've submitted this application, you are responsible for informing the Compassion Center staff as soon as possible.
Questions?
Please contact the Compassion Center for additional assistance - Phone: 404-781-9258 or by email at: bop@compassionga.org.
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