Car Donation Application

Please complete the entire application as failure to do so will automatically disqualify you for assistance.

*Indicates a required field

TO QUALIFY FOR SERVICES from Pearl Promise for you or your child(ren), you must:

Be a single parent with at least 50% legal custody to a child/children under 18 years of age
Reside in Boulder County (preference in services are first given to St. Vrain Valley School District Residents)
Be receiving some form of government of public assistance
Be motivated to become self-sufficient
Be identified as someone in need of private or public assistance, or currently receiving services.
Be actively working, looking for work, going to school, or donating your time. We love to see that you are giving back to your community as the people in the community have graciously given to you in this time of need.
If you currently own a vehicle that is not in use/or running, we request that you donate the vehicle to Pearl prior to receiving the donated vehicle.

Proof will be required to be considered for a vehicle donation possibly including: filed child custody arrangements, divorce decree, pay stubs, etc. Additionally you will be required to provide insurance, should you receive a donated vehicle and agree to PEARL's No Re-Sale Policy which states that you may not sell the car for your own profit within 6 months of receiving the donation.

Before you Begin:

We estimate that the application will take about 30-45 minutes to complete.
You will need to submit a front and back image of your current, valid drivers license (cell phone photos are accepted)

Basic Information

Today's Date

First name

Last name

Phone

Can you receive texts at the above number?

Yes

Preferred Method of Contact

Phone

Text

Date of Birth

Eligibility Confirmation

Are you a single parent with legal custody of at least one child under the age of 18?

Yes

If yes, please list the names and ages of your children

Do you currently reside in Boulder County Saint Vrain School District

Yes

Are you currently employed?

Yes

List all monthly income. Please break down including, salary, child support, Social Security, disability benefits, etc.)

List all monthly expenses including rent/mortgage, utilities, phone, car payment, insurance, gas, food, medical expenses, etc. individually below (Please label e.g. rent - $10000, Utilities - $100, etc.)

Do you have a valid driver's license?

Yes

Please load your drivers license below.

Drivers License Upload

Vehicle Needs

Please list only your essential needs (e.g., number of seats, car seat space, automatic or manual). Do not include make, model, color, or drive type.

Describe the circumstances or specific events in your life that caused this immediate need for a vehicle. *

Do you currently have a vehicle that runs?

Yes

If you currently have a vehicle that runs, do you own the vehicle?

Yes

If "No", please provide an explanation of who owns the vehicle, and what the plan for that vehicle would be if you were to receive a donated car?

NOTE: We ask that you donate your vehicle to PEARL in exchange for receiving a donated vehicle, even if it is not in running order. If you have a vehicle registered in your name that you would not be willing to donate in exchange, please list why.

We require the recipients of donated vehicles to register and plate the vehicle through the state of Colorado, insuring the vehicle beforehand and providing PEARL proof of all listed above. Will you be able to do these things on your own financially?

Yes

Are there any current concerns or issues with your vehicle's safety or operation? (Please describe below)

How would participation in our car care clinic help you on your journey toward self-sufficiency?

We collect this information below in order to receive grant funding as a nonprofit. We do not share outside the organization.

Are you currently enrolled in higher education?

Yes

If yes, what are you studying?

List any education assistance you are receiving (student loans, grants, etc.) If none, please indicate.

Pearl Promise Program Participation

Is there anything else you'd like us to know about your situation? If none, please indicate below:

How did you hear about the Car Care Maintenance Program?

Pearl Promise highly encourages giving back through volunteering time. Are you able to become a Pearl volunteer?

Yes

Have you volunteered with Pearl Promise in the past?

Yes

If yes, please describe how you volunteered?

While Pearl highly recommends that clients attend a spiritual support group and/or meeting, church attendance is NOT required to be a recipient of assistance.

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

Yes

If yes, where and how often do you attend?

In the last year, have you had any major life changes? (i.e. new job, new home, new illness, relationship change, etc.)

Yes

If yes, please describe below:

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

Are you on schedule to accomplish these goals? Please explain.

Do you give Pearl Promise permission to use your image (such as photos or videos) for promotional purposes (e.g., website, social media, newsletters, or reports)?

Yes, I give full permission

No, I do not give permission

I give limited permission

If limited usage, please explain below what type of image(s) you are comfortable with us using (e.g., photos with back turned, no identifying details, car only, etc.):

Diversity Data (Optional)PEARL Promise values diversity and inclusion. The following questions are optional and are collected only for the purpose of grant reporting and demonstrating the reach of our programs. Your responses are kept confidential and will not affect your eligibility for services in any way.

Gender Identity

Female

Male

Prefer not to answer

By providing your electronic signature below, you agree that you meet the qualifications of Pearl Promise (see above) for assistance. Furthermore you agree to all policies and stipulations given with any possible assistance.

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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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