Points to Purpose: Learn. Earn. Grow.
Share your contact details, eligibility, interests, goals, and consent to join Points to Purpose.
Membership Applicant Information
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City
*
ZIP Code
*
Preferred Method of Contact
*
Call
Text
Email
Emergency Contact Name
*
First Name
Middle Name
Last Name
Emergency Contact Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Name (if age 16–17)
First Name
Middle Name
Last Name
Parent/Guardian Phone Number (if age 16–17)
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address (if age 16–17)
example@example.com
Parent/Guardian Signature (if age 16–17)
Goals and Support
What would you like to accomplish through Points to Purpose?
*
What support would help you participate successfully?
*
Employment assistance
Employment assistance
Educational assistance
Educational assistance
Mentoring or accountability
Mentoring or accountability
Community resources
Community resources
Other support
Membership Agreement
Also, please be reminded that nothing from Ivy House of Hope's members-only access, links, apps, Google classroom or documents are to be shared with anyone outside of Ivy House of Hope's program, facilitators, or members, at any time per the disclosure in your application.
Acknowledged
I understand that I am expected to participate respectfully, communicate consistently, and complete approved activities to earn points
*
Acknowledged
I understand that points and rewards are governed by program guidelines and that membership does not guarantee cash, gift cards, or any specific reward
*
Acknowledged
I understand that rewards are subject to availability and may not be transferred, exchanged, or redeemed outside of the program’s rules
*
Acknowledged
I agree to respect the privacy, safety, and dignity of other participants
*
Acknowledged
I understand that Ivy House of Hope is not an emergency, medical, or crisis service
*
Acknowledged
Consent and Signature
Permission to Receive Program Communications
*
Calls
Text Messages
Emails
Photo and Media Release Consent
I consent to the use of my photo and media for program-related materials only
Applicant Signature
*
Signature Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent or Guardian Signature (if applicant is age 16–17)
Submit Application
Submit Application
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