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
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
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
Date
Parent or Guardian Signature (if applicant is age 16–17)
Submit Application
Submit Application
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