Application Needs Updates
You're part of a strong community of parents and caregivers creating stability for PA families. While we can’t help everyone right away, your voice matters. This short survey helps us advocate for more resources, stay connected, and match you with future programs like childcare scholarships and community support. It only takes 8–10 minutes to complete—your input helps shape what comes next!
First Name
*
Last Name
*
Phone
*
Preferred Method of Contact
*
Phone Call
Email
Text
Email
*
Zip Code
Residence County
Montgomery
Bucks
Philadelphia
Other
About Your Family
Are you a single parent?
*
Yes
No
It is complicated
Are you the one adult living in your home with your children?
Yes
No
Number of Dependent Children
1
2
3
4
5+
Please list the birth years of the children who live with you:
Current Children Needs
What kind of support system do you have for childcare?
I have friends/family who help regularly
I have friends/family who help only in emergencies
I have no one I can rely on for childcare
Do you have a job that requires you to find summer childcare?
Yes
No
Will you need childcare this summer (June through August)?
Yes, full-day care
Yes, part-time care
Yes, but only for certain weeks
Maybe/Not sure yet
No
What are your current childcare plans for the summer (if any)?
Your Daily Life
Do you have access to a reliable vehicle?
Yes
No
Sometimes/Shared Vehicle
Current Living Situation
Rent or own a house or apartment
Shelter
Transitional Housing
Homeless
Sharing house or apartment with family or friends
Do you currently receive help from any of these programs? (Select all that apply)
Child Care Works (CCW)
SNAP (Food Stamps)
TANF (Cash Assistance)
Medical Assistance
Housing Support (Section 8, vouchers, etc.)
None of these
Employment & Career Goals
What is your current work status?
Not working
Working part-time or underemployed
Working full-time
In job training or education
I want to do a job training
Other
Work Status- Other (Please explain)
What are your goals over the next few months? (Check all that apply)
Return to work
Increase work hours
Start job training or education
Change or grow in my career
Maintain my current work situation
Other (Please explain)
Goals- Other (Please explain)
Barriers to Achieving Your Goals
What are the biggest obstacles currently affecting your stability and goal achievement? (Check all that apply)
Lack of affordable childcare
Transportation
Unstable housing
Physical health
Mental health
No local support system
Past legal issues
Limited education/training
Other (please explain)
Obstacles- Other (please explain)
At Along The Way, we believe in the potential of every person and strive to create programs that eliminate obstacles to people achieving their potential.
In order to create meaningful programs, we need to know what’s holding folks back from achieving their dreams. Given this, is there anything else you want us to know/share about your situation?
Thank you for sharing your story.
We’ll use this information to help match you with programs and scholarships that support your goals.
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