F O C U S P E A R L P R O G R A M

A P P L I C A T I O N Part A

Pearl Promise Programs & Services Qualifications

Incomplete applications will not be considered. Failure to complete the entire application will automatically disqualify you from receiving assistance. *Indicates a required field.

You must be a single parent with at least 50% legal custody of one or more children under 18 years of age
You must reside in Boulder County, preferably within the St. Vrain Valley School District.
You must currently be receiving some form of government or public assistance.
You must demonstrate motivation to become self-sufficient.

Before you Begin:

It will take approximately 60 minutes to complete this application.
Please provide as much detail as possible to help us understand your situation. Documentation (such as Proof of Residence, Employment, and/or copies of bills with account information) may be required.
Please note that submitting an application is the first step in the process and does not guarantee approval or fulfillment of the request. All applications are reviewed based on established criteria, availability, and eligibility. We appreciate your understanding and patience as we evaluate each request carefully.

GENERAL INFORMATION

Today's Date

Full Legal Name

Contact Phone

Can you receive texts at the above number?

Yes

ELIGIBILITY

Are you a single parent with at least 50% legal custody of one or more children under the age of 18?

Yes

If yes, please list the names and ages of your children. If not, please cancel your submission. Pearl Promise programs are available ONLY to single parents with at least 50% legal custody of a child under 18 years of age.

Do you currently reside in Boulder County?

Yes

Address (include Street Address, Unit #, City, State, Zip)

What school district are you in?

Please attach proof of residency in Boulder County (e.g. Drivers License, Utility Bill, Rent document)

Are there any other adults - aged 18 or older - living in the home? If so, please list their names, relationship to you, and their financial contribution.

EDUCATION

Are you currently attending, enrolled, or planning to enroll in any type of schooling? Please indicate name of institution, what you are studying, and how far along you are in the program.

EMPLOYMENT

Are you currently employed?

Yes

Please indicate the Name of Company, your Position/Title, and how long you have worked there. If you are NOT employed, enter "NA"

If NOT employed, how long have you been out of work? What was your last job? What happened to cause you to leave? If you ARE currently employed, enter "NA"

If NOT employed, are you currently looking for work?

Yes

Not Applicable - currently working

What type of work are you looking for? If you ARE currently employed, enter "NA"

FINANCES

What is your monthly income? Please list each type separately such as: Salary, Child Support, Social Security, Disability benefits, TANF, etc. For example: Wages - $2000/month; Child Support - $250/month; etc.

Do you receive Housing assistance?

YES

What are your monthly expenses including rent/mortgage, utilities, phone, car payment, insurance, gas, food, medical expenses, etc. Please list individually. For example: Rent - $1800/month; phone - $100/month; fuel - $75/month

Pease list any type of ongoing support you receive from relatives, friends, or other individuals; this may include financial support as well as practical assistance such as childcare or transportation. If none, enter "NA".

Do you owe anyone money? What is the amount of debt you owe to any type of creditor? Include past due bills & amounts. Include credit cards, personal loans, family loans, etc.

Are your bills/payments currently up-to-date?

YES

If not, please explain. If all of your bills are paid with nothing currently due, enter "NA"

MOTIVATION

What goals have you been able to achieve toward self-sufficiency in the past 6 months? What are the obstacles or challenges that get in your way?

How have you tried to improve your financial situation, living situation, parenting or personal challenges?

What is your current plan to reach self-sufficiency? (e.g. attend school, buy a car, start applying for higher paying job, etc.)

WHY PEARL PROMISE?

How did you hear about the Focus Pearl program? Who referred you to us?

What about the Focus Pearl Program interests you? What would you hope to gain from the experience?

Please indicate any Pearl Programs that you have participated in and/or benefitted from in the past.

Please list single parents you know who have participated in Pearl Promise programs.

Have you ever volunteered with Pearl? If yes, please describe when, where, and with whom.

Are you currently attending a weekly spiritual support group and/or meeting?

Yes

If yes, where? How often do you attend?

Please provide one or two personal references who can tell us why you would be a good candidate for this program. List name, ph#, and email address. This might be a friend, coworker, neighbor, acquaintance from church, etc.

Please provide one or two professional references who can tell us why you would be a good candidate for this program. List name, ph#, email address/ This could be a supervisor, teacher, coach, etc. - someone who has had some authority in your life.

Have you attended an informational meeting with the Client Engagement Manager so that you understand the Terms of Accountability in the Focus Pearl Program?

Yes

My appointment is scheduled

Your signature signifies that all of the information you've provided is accurate and true. Completing this application does not guarantee assistance or admittance to the program.

Signature

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PLEASE NOTE: You have completed PART A of the Focus Pearls application process; if you are qualified based on the information provided, you will receive a link to PART B within 3 days. All potential candidates will be interviewed by the Client Engagement Manager.

PEARL is a Christ-centered organization providing single-parent families the hope and skills necessary to build an economically and emotionally stable home environment through sustainable programs.

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