Getting AheadThe Family Self-Sufficiency Initiative presented by the Augusta Partnership for Children, Inc. is intended to help those who do not typically have a voice, gain a seat at planning and decision making tables for issues surrounding self-sufficiency. As a participant, you will be serving as a problem solver contributing to community solutions by finding solutions to your own hardships.DIRECTIONS: Please FILL out your responses to the questions below. The information you provide will be used to determine your fit for this position. Please answer each question accurately and truthfully to the best of your knowledge.Gender *Please select an optionMaleFemaleOtherRace *Please select an optionWhiteBlack/African AmericanAsianAmerican Indian/Alaskan NativeNative Hawaiian / Other Pacific IslanderAmerican Indian/ Alaskan Native & WhiteAsian & WhiteBlack/African American & WhiteAm. Indian/Alaskan Native & Black/African AmericanOther Multi- RacialMailing Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Email Address *FamilyList the total number of Elderly participating in the program. *List the total number of Female Heads of Household participating in the program. *Is anyone in your household receiving Medicaid or Food Stamps? *Marital Status *Please select an optionMarriedNever MarriedDivorcedWidowedHousing InformationDo you currently rent or own your home? *RentOwnDo you currently live in Public Housing? *YESNODo you currently live in Subsidized Housing? *YESNOEducational BackgroundWhat is your highest level of education completed? *Are you currently in school now? *YESNODo you have any Degrees or Certifications? *YESNOPlease list Degrees or Certifications here:Employment Information & Income InformationAre you currently working more than 20 hours per week? *YESNOWhere are you currently working? *How long have you been working at your current job? *0-1 yrs1-3 yrs3-5 yrs5+ yrsWhat is your current position? *Monthly Income: *Please list ALL sources of income: *How do you get to work? *Own CarBusRideOtherAUTOBIOGRAPHICAL STATEMENTBy submitting this form, I agree that all information provided is true, to the best of my knowledge. I agree that I meet all eligibility requirements for participation in this program and I acknowledge that I am required to participate in ALL components of this program: Getting AHEAD curriculum training, Referrals, Lunch-N-Learn Sessions and Mentorship.Register Now
