“B.R.I.D.G.E to Success” Enrollment Form

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Our intake process strives to provide you with individualized attention to meet your specific needs. This allows us to gather background information about your family unit so we can begin the process of determining the best fit for your current needs. During the COVID-19 pandemic, B.R.I.D.G.E. to Success staff are working remotely and will do our best to connect with you by phone or email.

Program Eligibility:
-The family must reside within Davidson County.
-Child is a student at a Community Achieves Elementary, Middle or High School within Metro Nashville Public School System. This is preferred but not required. Students who attend non-Community Achieves schools are eligible based on meeting the remaining program criteria.
-Child/ren must qualify and/or receive free or reduced lunch via the National School Lunch Program.

Participation Commitment: The BRIDGE to Success Program utilizes a two generational approach, which provides services/resources/programming that will cater to the needs of your entire family. In order to remain in compliance with our program guidelines and successfully track each individual's progress, we require the engagement and activism of all participants: the caregiver/parent and child/ren

Email *

First and Last Name *

Phone Number *

Address and Zip Code *

Age Range *

19-24

25-34

35-44

45-54

55 and over

Parent Date of Birth

YYYY

Gender *

Female

Male

Prefer not to say

Other:

What is your race or ethnicity? *

Black or African American

Hispanic, Latino, or Spanish

White

Asian

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

Prefer not to say

Other:

How many school aged children (in your household), would you like to enroll in this program? *

Please provide child/ren names and date of births. *

Do you have a child or children at one of the following schools? *

Creswell Middle School.

Mckissack Middle School

Haynes Middle School

Whites Creek High School

Purpose Prep Charter School

Other (Community Achieves Elementary, Middle or High Schools preferred. Please specify per student)

If answered "Other" for previous question, which Community Achieves affiliation school does your child/ren attend? https://www.mnps.org/communityachieves

What is the grade level of your child or children? * (For High School Students: 9th and 10th graders are strongly preferred) *

Does your child/ren qualify to receive free or reduced lunch at their school? *

Yes

Other:

Marital Status *

Single

Married

Divorced

Widowed

Other:

If married, is your spouse interested in being a program participant as well? *

Yes

N/A

Highest level of education completed *

Less than High School Diploma

High School or GED

Vocational Training

Some College

Associate’s Degree

Bachelor’s Degree

Master’s Degree

Doctorate/Ph.D

Other:

Are you currently enrolled in an ESL, GED, Vocational, or Higher Educational Program? *

Yes

Current Employment Status *

Full-Time

Part-Time

Temporary

Student

Self-Employed

Unemployed

Other:

What is the name of your employer? *

What is your total household income? *

Less than $10,000

$10,000 to $19,999

$20,000 to $29,999

$30,000 to $39,999

$40,000 to $49,999

$50,000 to $59,999

$60,000 to $69,999

$70,000 to $79,999

$80,000 to $89,999

$90,000 to $99,999

$100,000 to $149,999

$150,000 or more

Are you interested in advancing your job or education? *

Yes

Maybe

Are you open to learning more about healthy lifestyle choices and opportunities? *

Yes

Maybe

Who referred you to the BRIDGE to Success Program? *

McGruder Family Resource Center

Gideon’s Army

Preston Taylor Ministries

Salama Urban Ministries

Metro Social Services

YMCA of Middle Tennessee

Other:

What benefit do you most hope to receive from the B.R.I.D.G.E. to Success program? *

Please review and agree to our expectations for BRIDGE Caregivers/Parents: (𝐀𝐥𝐥 𝐞𝐱𝐩𝐞𝐜𝐭𝐚𝐭𝐢𝐨𝐧𝐬 𝐬𝐡𝐨𝐮𝐥𝐝 𝐛𝐞 𝐜𝐡𝐞𝐜𝐤𝐞𝐝 𝐢𝐧 𝐨𝐫𝐝𝐞𝐫 𝐭𝐨 𝐩𝐫𝐨𝐜𝐞𝐞𝐝 𝐰𝐢𝐭𝐡 𝐁𝐑𝐈𝐃𝐆𝐄 𝐄𝐧𝐫𝐨𝐥𝐥𝐦𝐞𝐧𝐭) *

Biweekly, communicate with your Family Champion/Career Counselor, via phone or email.

Monthly, communicate with your Family Champion/Career Counselor to schedule a 𝐫𝐞𝐪𝐮𝐢𝐫𝐞𝐝, Zoom session or phone call to discuss and review your Family Assessment.

At the time of enrollment, complete an initial, electronic assessment.

Complete an end-of-year electronic assessment each December

Participate in at least 5-7 events for adults and youth per year offered by the program.

I understand that in the event I submit a financial assistance request, participation is one of the major factors that will determine approval/denial.

Required

Thank you for completing this intake form and most importantly, your interest in the BRIDGE to Success Program. Once your application is reviewed, you will be contacted regarding next steps. *

I understand and agree.

Submit

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