Outreach Agent Application 📱
Complete this form to apply for the Lifeline outreach program and share your experience and motivation.
SECTION 1: BASIC INFORMATION
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City / State
*
Do you have reliable transportation?
*
Yes
No
Are you willing to travel locally for outreach?
*
Yes
No
SECTION 2: AVAILABILITY & COMMITMENT
What type of position are you looking for?
*
Full-Time
Part-Time
Flexible / Side Income
How many days per week can you work?
*
What hours are you typically available?
*
When can you start?
*
-
Month
-
Day
Year
Date
SECTION 3: EXPERIENCE
Do you have experience in any of the following? (Check all that apply)
*
Sales (Door-to-door, retail, events, etc.)
Customer service
Community outreach
Working with government programs (Lifeline, ACP, etc.)
None
Briefly describe your most relevant experience:
Have you ever worked a commission-based or performance-based role?
*
Yes
No
If yes, what were your results? (numbers if possible)
SECTION 4: REAL-WORLD SCENARIO
If we dropped you in a new neighborhood today, how would you find places to set up and enroll customers for free phones?
*
SECTION 5: PARTNERSHIP & OUTREACH SKILLS
Have you ever approached a business, church, or organization to set up an opportunity?
*
Yes
No
If yes, explain what you did and the result:
Scenario: You walk into a corner store or church and ask to set up. The owner says “I’m not interested.” What do you say or do next?
*
SECTION 6: TARGET MARKET UNDERSTANDING
Who do you believe qualifies for the Lifeline/free phone program?
*
Where would you go to find qualified customers? (Check all that apply)
*
Grocery stores
Gas stations
Churches
Low-income housing areas
Social service offices
Community events
Other
SECTION 7: MINDSET & WORK ETHIC
This is a 1099 opportunity with no hourly pay. Are you comfortable working based on performance?
*
Yes
No
On a scale of 1–10, how comfortable are you approaching strangers?
*
Not comfortable
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Not comfortable, 10 is Very comfortable
What motivates you more?
*
Stable hourly pay
Unlimited earning potential
Why do you believe you would succeed in this role?
*
SECTION 8: GOALS
How much do you want to earn per week?
What would you do to hit that number consistently?
SECTION 9: EQUIPMENT & READINESS
Do you have any of the following? (Check all that apply)
*
Smartphone
Tablet (optional)
Internet access
Are you comfortable using apps to enroll customers?
*
Yes
No
SECTION 10: FINAL COMMITMENT CHECK
This opportunity requires you to go into communities, talk to strangers, build relationships, and stay consistent even when it’s challenging. Are you ready to show up and treat this like a business, not just a job?
*
Yes – I’m ready
Not sure
OPTIONAL: Record a short 30–60 second video introducing yourself and explaining why you’d be a great Outreach Agent.
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