Program Application

top of page

Use tab to navigate through the menu items.

The Whole Person Project

Transitional employment for those that are experiencing homelessness.

This is an application for those who have completed or will soon complete a drug or alcohol recovery program.

What are you hoping to get out of the Program? What jobs are you looking for in the short-term:

Long-term employment goals:

First Name

Phone

Last Name

Email Address

Are you currently dealing with any of the following issues? (Please check all that apply.)

Substance Abuse

Mental Health

Homelessness

All of the Above

Are you receiving treatment or assistance for any of the following? (Please check all that apply.)

Substance Abuse

Mental Health

Homelessness

All of the Above

Street Address

Are you in a Minority Group?

Current Age

Are you a Veteran?

Gender

Are you currently homeless?

Do you have a State Required ID?

Have you ever received Disability Benefits in the past?

Do you receive SNAP (Food Stamps)?

Do you need Employee Assistance?

Do you have a Social Security Card?

Do you feel you are eligible to receive Disability Benefits?

Do you currently have Medicaid?

List your work skills:

Education / Certifications:

Transportation

List any Criminal Background issues:

Any additional comments that will help you become Employment Ready:

Add to mailing list

I accept terms & conditions

Today's Date

Thanks for submitting! A team member will be in touch.

bottom of page