Single Parent Family Program Application for Admission

Application for Admission

Location

Please choose which location you are applying for.

Second Location

If your first choice location is not available, would you accept another location?

If so, which location is your second choice?
What is your relationship with the single parent?

Personal Information

Marital status
Are you a U.S. citizen?

Children's Information

Please tell us your child's full name, date of birth and their father's full name and address.

Will this child live with you?
Do you have legal custody of this child?

Please tell us your child's full name, date of birth and their father's full name and address.

Will this child live with you?
Do you have legal custody of this child?

Please tell us your child's full name, date of birth and their father's full name and address.

Will this child live with you?
Do you have legal custody of this child?

Please tell us your child's full name, date of birth and their father's full name and address.

Will this child live with you?
Do you have legal custody of this child?

Please tell us your child's full name, date of birth and their father's full name and address.

Will this child live with you?
Do you have legal custody of this child?

Health

Are you coping with any health issues at this time? (Check all that apply to you.)
Is there any physical or mental reason you cannnot attend school and/or work?

Education, Transportation, Employment and Financial Resources

Have you completed high school?
Have you attended a college or trade school?
Do you have a current driver's license?
Do you have your own vehicle?
Are you currently working?
Financial status

You may be asked to provide your financial status pay stubs, last year's tax return, bank statements, and/or other verifications of above listed monetary awards to prove eligibility for services.

Criminal History

Criminal History

Please check any of the following that apply.

Goals

If accepted into the SPF program, my goals while living there would include:

As much as possible, please describe specifically what you want to do in each of the areas you marked above.

The information I (the applicant) have provided in this application is correct to the best of my knowledge. I understand that falsifying information or withholding information would be reason for termination of services.