The EVOL Project Pre-Application

First name

Last name

Email

Birthday

Last four Social Security Number

Address

Please upload a picture of your State Driver's License or ID Card

Referral Source/Name (How did you hear about the program)

Referral Source Email (If program information was found online, please type N/A)

Are you an adult who aged out of the foster care system?

Yes

No

If so, what is/was your ID number?

What is your current living situation?

Transitional Host Home

Living in own apartment or house

Living with family

Homeless

Are you a recipient of SNAP, Medicaid or TAC benefits?

Yes

No

If so, what is your case number?

Please upload a copy of your most recent Notice of Case Action from DCF

If you are not a recipient, do you need assistance with applying for these benefits?

Yes

No

If you did not age out of the foster care system or you do not receive government benefits, you may still be eligible by verifying you meet the income guidelines. Please upload copies of your last two paystubs for income verification.

Have you ever enrolled in a GED Program?

Yes

No

If so, which year?

Which subjects do you recall completing?

What is your highest level of schooling?

Are you married?

Yes

No

Do you have children?

Yes

No

If so, how many children do you have?

1

2

3

4 or more

What is you employment status?

Employed

Unemployed

If employed, where do you work?

If you are employed, what type of shift do you have?

Full-Time

Part-Time

If you were previously registered in a GED Program, what was the reason why you did not complete the program during your first enrollment? if this is your first time, please type N/A.

What will make this time different if this is not your first time? Type N/A if this is your first time.

How will your completion of the program help you in the future?

What helps you stay focused?

PLEASE ACKNOWLEDGE: This is a pre-application for entry into the program. Once approved, you will be required to meet with a staff member from our team for an interview to verify your identity and the information included in this application.

PLEASE ACKNOWLEDGE: Once accepted into the program, you will be required to communicate with your GED Advisor at least once per week for continued enrollment up until completion of the program.

PLEASE ACKNOWLEDGE: Acceptance into the program will require a monthly meeting with Program Case Manager/Mentor up until completion of the program.

PLEASE ACKNOWLEDGE: Women Impacting Neighborhoods, Inc. reserves the right to approve or deny any applicant who does not meet program eligibility.

Please sign here acknowledging that all information included in this application is true and accurate.