Fresh Start for Success
Student First and Last Name *
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Student Address *
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City, State, and Zip Code *
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Contact Email Address *
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Contact Phone Number *
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School *
Grade *
Fresh Start for Success requires a recommendation from a school representative (counselor, social worker, TAP, or administration.) Your representative will be asked to share how obtaining the clothing items will positively impact you. The representative will also be contacted in a few months for a follow up on your employment or attempted employment.
Please list your school representative's first and last name. *
Your answer
Please select your school representative’s building. *
School representative’s email address *
Your answer
Where are you applying, or where have you obtained employment? *
Your answer
What clothing needs do you require for your interview or for this position that are not provided by the employer? Select all the apply. (Check with your employer on requirements before purchasing clothing.) *
Required
How soon do you need the item(s)? *
How would these items help you obtain or maintain employment? *
Your answer
By initialing this document, I agree to use the purchased clothing for its intended purpose. *
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