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 B

Congratulations!

You have completed Part A of the Focus Pearl Application.

In Part B, we will move beyond basic information to learn how Pearl can help you move to self-sufficiency. Please be as honest as possible.

Note: This information will not be shared outside of the Pearl Promise organization. Thank you.

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.

Today's Date

Full Legal Name

Contact Phone

Have you completed PART A of the Focus Pearl Program application?

YES

EDUCATION & TRAINING

What are your career aspirations and how will this career help you to become self-sufficient?

What are the training or education requirements for the job you want?

Please explain any plans you have to further your education in terms of career choices, educational aspirations, timing, and long-term goals. How will this career choice contribute to the goal of self-sufficiency?

Do you have a current resume'?

YES

Have you ever taken a Skills Assessment ?

YES

Have you ever taken a Personality Assessment that helps you understand what kind of job suits you?

YES

What are the best and worst work-related and/or education-related decisions you have ever made?

EMPLOYMENT

Other:

BUDGETING & FINANCE

In what practical ways do you economize to stretch your resources? Think about essentials such as food, clothing & transportation as well as non-essentials like hair & nail care, entertainment costs, etc.

What are the best and worst financial decisions you have ever made?

Are your bills currently up-to-date?

YES

Have your utilities such as gas & electric, or your telephone or internet services ever been shut off for non-payment?

YES

How often must you pay banking fees for late payments or bounced checks?

Never

Weekly

Monthly

Other

PARENTING

What are the best and worst parenting decisions you have ever made?

Who do you to turn to, or where do you go for parenting advice?

How would you hope that being in this program could impact your parenting skills and influence your home environment?

ABOUT YOU

Other:

How often do you consume alcoholic beverages?

Not at all

Occasionally

Frequently

Daily

Please note: Our goal is to maintain a safe, healthy, and supportive environment for all participants and their families. Although marijuana use is legal in the State of Colorado, Pearl Promise does not support the use of marijuana or any other non-prescribed drugs while participating in program activities or while receiving services through the program. Participants are expected to remain free from substance use during their involvement in the program unless the substance has been legally prescribed by a licensed medical professional and is used as directed.

How often do you use any form of marijuana?

Not at all

Occasionally

Frequently

Daily

Do you use marijuana due to medical concerns based on a diagnosed condition? If yes, please explain. If no, enter "NA".

Do you currently use marijuana (in compliance with state law) or any illegal drugs?

I use marijuana legally under state law

I use illegal drugs (not permitted by law)

I do not use marijuana or illegal drugs

Are you aware that using illegal drugs while in the Focus Pearl program is grounds for dismissal?

Yes

Are you aware that the Client Engagement Manager and/or Executive Director may request drug testing of any Focus Pearl at any time?

Yes

Please provide a brief summary describing why you feel you should be selected for this program.

The selection process for the Focus Pearl program is highly competitive. Due to the number of applicants, limited spots available, and finite resources, we trust our clients to be meet program requirements as described in the Focus Pearl Handbook.

Are you able to commit to the following over a 12-month period? Clicking the box next to each statement signifies "YES". If selected for the Focus Pearl Program ...

I agree that my interactions with the Client Engagement Manager will be based on the principles of "A-C-T" - Accountability, Communication, Truthfulness.

I agree to monthly meetings with the Client Engagement Manager. If I am going to be late or miss an appointment. it is my responsibility to communicate and reschedule.

I agree to work with the Client Engagement Manager to develop S.M.A.R.T. goals in the areas of Budget & Finance, Education & Training, Employment, Parenting, Health & Self-Care, and Spiritual Self-Awareness.

I recognize that this program is more than a monthly stipend and I agree to read materials provided in the Learning Modules and apply Life Actions as suggested each month.

I agree that it is my responsibility to provide feedback on the Learning Modules/Life Actions AND to track progress on my own S.M.A.R.T. goals.

I agree to complete and submit a budget sheet that shows my income and expenses on a monthly basis.

I agree to inform the Client Engagement Manager of significant changes that occur that impact my income or my household needs. Examples: job loss, an increase or decrease in Housing, EBT, lack of food resources, car or health emergencies, etc.

I agree to volunteer for Pearl Promise events or activities as described in the Focus Pearl Volunteer Policy at a rate of one hour per month or three hours per quarter for a total of 12 hours in one year.

By signing below, you are attesting 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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