PROGRAM ELIGIBILITY APPLICATION

CONTACT INFORMATION
Name *
Name
Residence Address
Residence Address
Mailing Address
Mailing Address
If different from above residence address
Cell Phone *
Cell Phone
Day Phone *
Day Phone
Evening Phone *
Evening Phone
ALTERNATE CONTACT PERSON
This is someone who can get a message to you if we cannot reach you
Contact Name
Contact Name
Phone
Phone
Program Information
How did you hear about this Twin Cities R!SE?
Verification of Eligibility
Answer all of the following questions:
I am 18 years or older.
I made less than $25,000 last year.
You will be asked to provide income tax forms (or other statements) to document your income for the last year.
I am willing and able to work full-time in the State of Minnesota.
I am eligible to be legally employed in the United States now and for the next two years.
You will be asked to provide documents proving your eligibility to work.
If you answered YES to all of the above, please continue. If you answered NO to any of the above criteria, please stop and talk to a staff member.
I have been convicted of a Criminal Sexual Conduct or arson crime.
If you answered No to all of the above, please continue. If you answered YES to any of the above criteria, please stop and talk to a staff member.
Have you previously applied to or attended any Twin Cities R!SE programs?
All information contained on this pre-application will be used for the sole purpose of determining eligibility for program admission and will be kept confidential.