ENROLLMENT APPLICATION
PERSONAL INFORMATION
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are You A Veteran?
*
Please Type YES or NO
Date Of Birth
*
-
Month
-
Day
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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EMPLOYMENT HISTORY/ ELIGIBILITY
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S?
*
YES
NO
ARE YOU CURRENTLY WORKING ?
*
YES
NO
IF YES, WHERE?
SHARE YOUR MOST RECENT EMPLOYMENT EXPERIENCE
EDUCATION BACKGROUND
DID YOU GRADUATE HIGH SCHOOL?
*
YES
NO
I GOT MY G.E.D.
DID YOU ATTEND/COMPLETE COLLEGE?
*
YES, I ATTENDED & COMPLETE
I ATTENDED BUT DID'T FINISH
NO, NEVER WENT TO COLLEGE
IF YES, WHERE DID YOU GRADUATE FROM?
IF NO, DO YOU WANT TO ATTEND COLLEGE?
YES
NO
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LEGAL HISTORY/STATUS
Current Status
*
Recently released from incarceration
Currently serving probation
Type of Offense
*
Felony
Misdemeanor
WHAT CHARGES ARE YOU CURRENTLY FACING OR ON PROBATION FOR?
*
Date of Release or Probation Start
*
-
Month
-
Day
Year
Date
ADDITIONAL QUESTIONS
Tell us about your goals and why you want to join Purpose Academy
*
Where do you see YOURSELF in 5 years?
*
How did you hear about Purpose Academy?
Please Select
Referral from probation officer
Community organization
Friend or family
Social media
Other
DISCLAIMER
I, the Applicant, certify that my answers are true and honest to the best of my knowledge. I Also affirm that I give Progress Protection Agency Inc. permission to contact me Or my accountability contact to ensure I complete each course in it's entirety. I also affirm that I have not and will not receive or request any legal advice from Progress Protection Agency Inc. I acknowledge that I alone are responsible for achieving my goals and plans set during the course for this program.
Signature
Submit Application
Submit Application
*
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APPLICATION FEE
$50.00
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
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