AlongTheWayPa -

Thank you for taking the time to complete an application for the CADCOM + Along The Way Transportation program. Once your application has been completed, our Director of Programs and Case Manager Supervisor will review and provide you with a response on whether you are OR are not eligible for the program.

For any questions please contact:

Along The Way:

Director of Programs: Sara@alongthewaypa.org

Case Manager Supervisor: Daisia@alongthewaypa.org

CADCOM:

Director of Micro-Enterprise Center: cyburke@cadcom.org

Full Name *

Phone *

Email *

Residence County *

Do you have a referring organization? (This is required for the program) *

Yes

Which organization referred you to this program? *

Describe household size *

Number of Dependent Children *

Number of adults living in the household (18 years and older) *

Demographics

Ethnicity *

Highest Level of Education *

Are you a Veteran *

Yes

Marital Status *

Gender *

Employment Information

Employment Status *

How many hours per week do you work? *

How long have you been at your current employer? *

3-11 months

1 year

2 years

3 years

4 years

5 years+

What is your monthly income from employment only? If non, record N/A *

What is your monthly income from all other sources (SSI, Child Support, Cash Assistance, Etc) If none, record N/A *

Employer Name *

Employer Address *

Employers Contact Information (Name, Number) *

Do you have a valid drivers license? (This is a requirement of the program) *

Yes

Application Personal Statement

Please explain why you are interested in participating in the transportation program: *

For this program, you are required to complete online financial education courses and provide proof of a monthly deposit to a separate savings account. Are you able to make this commitment at this time? *

Yes

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