FRESH START SUPPORT REQUEST FORM

BOBCCPROS Fresh Start Pathway Application

Fresh Start is a limited-capacity BOBCCPROS coaching and support pathway for individuals who are ready to work toward meaningful change in their mindset, habits, financial stability, career readiness, education, digital skills, or overall life direction.

Some Fresh Start spaces may be offered at a reduced cost or at no cost based on eligibility, available funding, and program capacity. Submission of an application does not guarantee acceptance.

Full Name

Email

Phone

Preferred method of contact

Text

Email

Phone call

Date of birth

Month

Day

Year

Address

What would you most like to change or improve in your life right now?

Why is making this change important to you right now?

What would you like your life to look different six months from now?

Are you willing to actively participate in Fresh Start by attending scheduled sessions, completing agreed-upon activities, practicing new skills, and working toward the goals you establish?*

Yes

No

I am not sure yet

Which statement best describes you right now?*

I am ready to make changes and want help creating a plan.

I know I need change, but I am not sure where to begin.

I have started making changes and need structure and support.

I am mainly looking for information or resources right now.

If employment is one of your goals, what type of work are you interested in?

Do you currently have a resume?

Yes

No

I need help updating it

Not applicable

File upload

Would you like to receive information about legitimate employment opportunities that BOBCCPROS may become aware of?

Yes

No

Maybe later

Would you like to be considered for reduced-cost or no-cost Fresh Start access if available?

Yes

No

Either option is okay

If you are requesting reduced-cost or no-cost access, briefly tell us why this assistance would help you participate.

Do you currently have reliable access to a computer or laptop? *

Yes

No

Sometimes

I mainly use a smartphone or tablet

Do you currently have reliable internet access?*

Yes

No

Sometimes

Is transportation something that may affect your ability to participate in an in-person Fresh Start activity?

Is there anything else you would like BOBCCPROS to know?

I understand that the BOBCCPROS Fresh Start Pathway provides education, coaching, practical skills training, career-readiness support, budgeting support, DIY credit education, and resource guidance. I understand that Fresh Start does not guarantee employment, credit-score changes, debt reduction, income increases, financial results, admission to an educational program, or any other specific outcome. I understand that Fresh Start is a limited-capacity program and submitting this application does

I understand that Fresh Start is a limited-capacity program and submitting this application does not guarantee acceptance or reduced-cost/no-cost participation.

I understand that if I am accepted, I am expected to actively participate in the program and work toward the goals and next steps I establish.

I give BOBCCPROS permission to contact me regarding my Fresh Start application and available program options.*

Confirm with your initials