The Dannon Project: Application

The Dannon Project: Application

Please complete the form below. An asterisk marks a required field.
Date of Application*

MonthDayYear
Date
Name:*

First NameMiddle InitialLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
County*
Other County
Neighborhood
E-mail:
Cell Phone Number:*
Emergency Contact Name

First Name (EC)Last Name (EC)
Emergency Contact Number:
(Family member, spouse, partner, friend, etc.)
Emergency Contact Relationship
Social Security Number
000-00-0000
Date of Birth*

MonthDayYear
Age*
Marital Status:*
Gender*
Race*
Form of Identification*
Social Media Handle (enter at least one...Facebook, Instagram, etc.)
If we can't reach you by phone, we can try to contact you through Social Media...if you approve.

EDUCATION INFORMATION
Highest Grade Level Completed*
Have you ever been expelled from school?*

YesNo
Did you attend college?

YesNo
If so, how many years?
Do you need your GED or High School Diploma?*

YesNo
Name of Last School Attended*
City, State of Last School Attended*
City, St
Last Year of Attendance*
Type of Diploma/Certificate Earned*

MILITARY SERVICE
Are you a Veteran?*

YesNo
If yes, do you have your DD214?

YesNo
Branch of Service
Are you currently receiving any Veteran Services?

YesNo

EMPLOYMENT INFORMATION
Are you currently employed?*

YesNo
If yes, Name of Employer
Length of Employment
Enter a number
Do you receive TANF Benefits*

YesNo

APPLICANT ACKNOWLEDGEMENT & CONSENT

Acknowledgement of Information
I acknowledge that the above and the attached information is true to the best of my knowledge. I understand that I may be asked to provide documents of proof to verify the information. I will willfully provide. I further understand that providing false information to The Dannon Project for admissions in its program or for any reason may result in immediate termination from the program. I understand that if The Dannon Project requests that I provide additional information to determine my eligibility for enrollment that I must adhere to the requests thoroughly and within a reasonable time frame. I understand that if I am not accepted into any Dannon Project Programs, that I will be notified of reasons for termination or denial.
Signature*

Clear
Use mouse or finger
CONSENT FOR RELEASE OF INFORMATION
I authorize and provide consent to The Dannon Project funders and collaborative partners to release information gathered and collected while you are a participant in The Dannon Project for the expressed purpose of coordinating support services and linkages with federal and state agencies, community organizations, social service agencies, and faith-based programs to assist my transition.
Signature*

Clear
Use mouse or finger
Date*

MonthDayYear
Date
Referred by
Enter the name of the person who referred you to us (Friend, Family Member, Judge, Lawyer, Self, etc.)
TDP Staff Member
(If a Dannon Project staff member recruited or assisted you with this application, enter their name)
Special Notes:
This workforce product was funded by a grant awarded by the U.S. Department of Labor's Employment and Training Administration The product was created by the recipient and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, adequacy, continued availability, or ownership. This product is copyrighted by the institution that created it.
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The Dannon Project: Application

EDUCATION INFORMATION

MILITARY SERVICE

INCARCERATION INFORMATION

EMPLOYMENT INFORMATION

SUPPORTIVE SERVICES

PERSONAL GOAL SETTING

APPLICANT ACKNOWLEDGEMENT & CONSENT

CONSENT FOR RELEASE OF INFORMATION