Prosper Placer Ally Application

Prosper Placer Ally Application

Application to become an Ally to a family currently living in poverty
Personal and Contact Information
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone:
Cell:
E-mail
Preferred Contact:*
phone number or email address
Age Range:

16-1920-3031-4041-5051-6061-7070+
Are you affiliated with a church or service group that supports Prosper Placer?

YesNo
If so, what group?
Describe your interest in Prosper Placer
What interests you about Prosper Placer?
(Box will expand to accommodate your response)
Please describe your personal qualities, experiences, and background that could contribute to Prosper Placer and help participating Change Leader families:
(Box will expand to accommodate your response)
Please describe any personal or professional experiences with poverty:
(Box will expand to accommodate your response)
The 14-week training for Change Leaders and Allies is called the Learning Exchange because we believe we are all learning together. People can experience poverty in different aspects of life: physical, mental, emotional, social, spiritual, as well as financial—We can all experience a lack of fullness at some point in our lives. Goal setting and directing the change process in our own lives is an important life skill.
Please describe an aspect of your life that you have worked to improve. What are some areas/things in your life that you would still like to improve or work on?
Commitment

Because you will have contact with families with children, fingerprinting of all volunteers is required. Prosper Placer will reimburse for the cost of fingerprinting, or you may donate this expense.
A major component of this program is weekly meetings. Change Leaders and Allies will learn strategies and set goals to get out of poverty. Change Leaders must demonstrate their commitment to the program and their motivation to get out of poverty before they are matched with their Allies. Allies develop an understanding of the complexity of poverty in order to better support their Change Leader individual or family.
I am able and willing to commit to participating in weekly meetings on Monday evenings. (Occasionally I may have to miss (ie. vacation, family commitments)

YesNo
After the 14-week Learning Exchange, graduates are partnered with Allies (community volunteers) and meet together a minimum of once a month to work on goals.
I understand if I commit to a family after the Learning Exchange, it is an 18 month commitment. If I choose to continue, I will commit to meet with my Change Leader family and other Allies on my team at least once a month, and I will periodically attend additional Prosper Placer activities with my Change Leader family.

YesNo
I understand that I will grow in my own understanding of poverty, class, and the systems that impact people’s ability to be upwardly mobile. I welcome this opportunity and will be open to new understandings.

YesNo
Signature

I understand that I will be making a commitment that will impact the lives of other people in this program.
Please select one of the following:*

I agree to making this commitment for the upcoming series.I am considering a future commitment, please contact me when the subsequent series begins.
Date:*

MonthDayYear
Should be Empty:

Prosper Placer Ally Application

Personal and Contact Information

Describe your interest in Prosper Placer

Commitment

Signature