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Serenity Pathway Companion
Career Training Support
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Applicant Information
Section 1 of 10
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Section 1
Tell us about
yourself
Let's start with the basics. This helps us get in touch and understand who you are.
Full Name
Date of Birth
Age
Phone Number
Email Address
Current Address
City / State / Zip
Emergency Contact
Contact Name
Relationship
Phone
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Section 2
Current
housing
situation
Select all that apply to your current living arrangement.
Where are you currently living?
With family
With friends
Renting on my own
Temporary housing
Shelter
Currently homeless
At risk of losing housing
How long in your current situation?
Less than 3 months
3–6 months
6–12 months
More than 1 year
Do you currently receive housing assistance?
Section 8 / Housing Voucher
Transitional Housing
Family Support
None
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Section 3
Employment
& income
Tell us about your current work situation and how you get around.
Employment Status
Full-time
Part-time
Self-employed
Unemployed
Student
Monthly Income (approx.)
Employer Name
Job Title
Do you have reliable transportation?
Yes
No
Sometimes
Transportation type
Personal Vehicle
Public Transportation
Rides from Friends / Family
None
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Section 4
Education &
career goals
Share your educational background and where you'd like to go.
Highest education completed
High School Diploma
GED
Some College
Trade School
College Degree
Currently Enrolled
Career interests or goals
I'd like support with
Career Planning
Job Placement
Resume Development
Entrepreneurship
Real Estate / Investing Education
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Section 5
Life skills &
personal growth
Which areas would you like the most support in? Select all that apply.
Budgeting & Financial Literacy
Credit Building
Career Coaching
Time Management
Housing Stability
Education Advancement
Entrepreneurship
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Section 6
Health &
support needs
This helps us connect you with the right resources. All information is kept confidential.
Do you currently have health insurance?
Yes
No
Type of insurance (if applicable)
Medicaid
Employer Plan
Family Plan
Marketplace Plan
None
Any physical or mental health challenges to be aware of?
No
Yes
Please briefly explain
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Section 7
Program
readiness
We want to understand your motivations and how committed you are.
Why are you interested in joining Serenity Pathways?
What are your goals over the next 12 months?
How committed are you to working toward stability?
Very committed
Somewhat committed
Not sure yet
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Section 8
Program
participation
Here's what you'll have access to as a Serenity Pathways participant.
Mentorship
One-on-one guidance from experienced mentors
Financial Literacy
Workshops on budgeting, credit, and investing
Career Development
Job coaching, resume help, and placement support
Housing Support
Resources and guidance toward housing stability
Community Service
Projects that give back and build real leadership skills
Are you willing to participate in program activities?
Yes, I'm in
Not at this time
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Section 9
How did you
find us?
Help us understand how you connected with Serenity Pathways.
School Counselor
Social Worker / Case Manager
Church or Community Org
Friend or Family Member
Social Media
Other
If referred by an organization
Organization Name
Contact Person
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Final Step
Certify &
submit
You're almost there. Review and sign off to complete your application.
Program Mission
Serenity Pathways Foundation provides mentorship, career guidance, housing support, and life-skills development to help young adults transition into stable and independent living.
Anything else you'd like us to know?
Your Full Name (Signature)
Date
By submitting this application, I certify that the information provided is accurate to the best of my knowledge and I agree to engage honestly and respectfully with the Serenity Pathways program.
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submitted!
Thank you! Your application has been received and our team will be in touch with you soon.
📧 info@serenitypathwaysfoundation.org
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