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STABILITY | PURPOSE | RENEWAL

Application for Getting Ahead


PLEASE PRINT YOUR ANSWERS

Date_________________________________

Name__________________________________________________________________________________________

Email address____________________________________________________________________________________

Mailing Address ___________________________________________________________________ Apt #_________

__________________________, Texas Zip_______________ Phone #_____________________________________

Marital Status: ( ) Single ( ) Divorced ( ) Separated ( ) Married Date of marriage _____

DOB _______________________________________ Veteran: _____ Yes _____ No

Race _______________________ Ethnicity: _____ Not Hispanic _____ Hispanic _____Other

FAMILY: List all members in your immediate family, beginning with yourself.
Name Gender Date of Birth Relationship Do you have Living with
legal custody? you? Y/N
1. (yourself)

2.

3.

4.

5.

6.

7.

8.

9.

10.

Main Street Ministries Houston | msmhouston.org | 5100 Travis St. Houston TX 77002 | 281-833-3500
Employer_________________________________________________________________________________________
Phone # ____________________ Hourly Pay $ ________________________ Weekly hours _____________________
Supervisor ______________________________________________________

Employer_________________________________________________________________________________________
Phone # ____________________ Hourly Pay $ ________________________ Weekly hours _____________________
Supervisor ______________________________________________________

If applicable:
Spouse’s employer ______________________________________________________________________
Phone # ____________________ Hourly Pay $ ________________________ Weekly hours _____________________
Supervisor ______________________________________________________

A representative of Main Street Ministries will call to schedule your interview.

Bring the following documents to your interview:


 last two pay stubs
 current lease, if renting
 photo ID
 Social Security card
 You will be required to sign a release for a civil and criminal background check. The results of the
background check do not impact acceptance into Getting Ahead.

II. Head of Household and Referring Partner Representative sign below:

___________________________________________________________ __________________________
Signature - Head of Household Date

___________________________________________________________ __________________________
Name and Signature of Referring Partner Representative/Title Date

III. Email, or fax, the signed application to Hermette Ward, Getting Ahead/Family HOPE coordinator:
Hward@msmhouston.org
Fax 713-620-6501