Car Donation Application
Please complete the application in its entirety (fill in every question even if it's N/A -meaning->Not Applicable). We appreciate your full and honest answers.
(Failure to do so may resolve in an application rejection)


PEARL, on occasion, provides clients with a donated vehicle. We don't have/keep an inventory of vehicles and the wait to receive a car may be weeks or months. Donations are done on a first-come, first-served basis when a suitable vehicle is available to match the needs of a qualified recipient. 

To qualify for services from PEARL for you or your child/ children, you must:

  • Be a single parent with at least 50% legal custody to a child/children under 18 years of age
  • Reside in Boulder County (preference in services are first given to St. Vrain Valley School District Residents)
  • Be receiving some form of government or public assistance
  • Be actively looking for work, going to school or donating your time. If not, we will . We love to see that you are giving back to your community as the people in the community have graciously given to you in this time of need.

Proof will be required to be considered for a vehicle donation (i.e. divorce decree, child custody agreement, birth certificate for children, etc.) 

Recipients must possess a valid Colorado driver's license (NOT A PERMIT) and agree to provide insurance on any donated vehicles--proof of both will be required.
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Email *
      By continuing with this application you are confirming that you live alone are divorced, single/ never married or widowed. 
Please check the answer below that best fits your situation.
*
Required
-Full Name (Last, First, & Middle Initial)
-Phone Number
-Full Address for where you currently reside
 (Street name/number, city, state & ZIP Code)

*
Are you at least 18 years of age? Do you have a VALID drivers license (PERMIT NOT ACCEPTED) that you can show proof of today? *
Date of Birth *
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DD
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YYYY
Todays Date *
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DD
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YYYY
What do you prefer as your point of contact?
Phone/Text Message/ Email? 
(You may select all boxes if you would like)
*
Required
Please list the names & ages of any minor children in your care/household. *
Do you have 50% (or more) legal custody of your children? *
Please list ALL adults (18 years of age or older) currently living in your household.
Include their names & relation to you and If they contribute to your household & how?
*
Please list the person or agency that referred you to PEARL?
What are your specific needs when it comes to a vehicle? Number of seats, room for car seats, automatic or Standard transmission? We do our best to accommodate needs, but we do not work on a first come first serve basis.
(We are ONLY looking for specific needs to help accommodate you and your children. We do NOT need to know or consider preferred colors or specific makes & models)
*
Describe the circumstances or specific events in your life that caused this immediate need for a vehicle? *
Do you currently have a vehicle that runs and do you own this vehicle? If not please provide an explanation of who owns the vehicle, and what the plan for that vehicle would be if you were to receive a donated car?

NOTE: We sometimes ask that you donate your vehicle to PEARL in exchange for receiving a donated vehicle as long as we can register the vehicle (Meaning: It would have to be in your name with a clean title)
*
What is your Employment status?
 (Please be specific and include ->Job title, company, length of employment, and hours worked per week)
*
We require the recipients of donated vehicles to register, plate the vehicle through the state of Colorado, and insure the vehicle immediately and show PEARL proof of all listed above. Will you be able to do these things on your own financially? *
Are you currently enrolled in school? If so, where are you enrolled and what are you studying? *
What public assistance benefits are you currently receiving? Please check ALL that you have received in the past year.
*
Required
Have you received any assistance from the list below (non-government)? *
Required
List any educational assistance you are currently receiving (Including grants, student loans, Etc.)  *
List ALL OTHER monthly income you are receiving. Must list ALL sources & include their name and the amount they help you with.
NOTE: Be sure to include salary/ wages, child support, social Security, disability benefits, Etc.
*
Are you currently a participant in any of our programs? NOTE: Participation is NOT a requirement to be a participant. *
Have you received support/ services from PEARL in the past year? Please check ALL that apply *
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