Pima Cycle Breaker Application
The Pima County School Superintendent’s Pima Cycle Breaker Program (PCB) assists Pima County youth and adults by reengaging them with education, employment, and support services. PCB is designed to educate, employ, and support in a variety of fields. Individuals who commit to the program receive assistance with housing, transportation, food, tuition, and other needed benefits. This application is your first opportunity to make a change in your life that is positive and rewarding.
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First Name: *
Last Name *
Age *
Gender/Pronouns
Cell Phone/Home Phone *
Email
Mailing Address *
If Under 18 - Parent/Legal Guardian Name: *
If Under 18 - Parent/Legal Guardian Phone number including area code: *
What forms of ID do you currently have? *
Required
Education *
Required
How did you get referred to Pima Cycle Breaker? *
Support services you need assistance with: *
Required
Employment *
Required
If currently employed, who is your employer?
Agreement: I agree to be a respectful and responsible participant of the Pima Cycle Breaker Program. I am committed to working on the three pillars of Pima Cycle Breaker: Education, Employment, Support Services.
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