homeward bound brantford-brant eligibility checklist for ... · submit the application and resume...
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Homeward Bound Brantford-Brant
Eligibility Checklist for HB Referrals
Please use the checklist below to determine eligibility requirements for any Homeward Bound Brantford-Brant
referrals.
In order to be eligible to apply for the program, all eligibility criteria listed below must be true.
If all statements are true, please complete the referral form on pg. 2.
Program Eligibility Checklist
Single mother 19+. Does not have a partner living with her.
Is a Canadian citizen, permanent resident, or convention refugee.
Has custody of at least one child under the age of 17 who is living with her.
Is not currently experiencing legal issues involving FACS.
Maximum of 3 children living with her.
Is substance abuse free for at least 1 year.
Has no current criminal proceedings.
Is able to participate in a full-time program.
The following criteria is preferred, but exceptions may be considered on a case-by-case basis:
High school diploma, equivalent, or only 1-2 credits away from a diploma.
No previous post-secondary experience and/or unresolved OSAP debt.
Other eligibility criteria may apply.
NEXT STEPS:
1. Have your client complete an application and resume and return to you.
2. Submit the application and resume to the Homeward Bound Coordinator along with this checklist and your
referral form.
3. Upon our receipt and review of referral, application, and resume, clients may be asked to attend a Homeward
Bound information session.
4. If selected to proceed through the process clients will be asked to attend interview and assessment sessions.
5. Interviews and assessments must be completed before a client will be considered a program candidate.
6. Send submissions or questions to Dione Winter:
Email: [email protected] Phone: 519-771-1592 Fax: 519-758-9394
Is receiving, or is eligible to receive Ontario Works (OW)
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Homeward Bound Brantford-Brant
Referral Form
Date
Referring Agency Information Agency
Contact Name
Phone Number
How long have you been working with this individual?
Why do you feel that this individual is suitable to undertake a 4 phase, multi-year commitment for the Homeward Bound program?
Client has given their permission to share their contact information.
Client has given their permission to share other personal information attached.
Client Information Name
Phone Number
Date of Birth
Client consent to share contact and/or personal information
I, ____________________________ hereby give permission to Ontario Works Brant to share my information with
Brant Skills Centre; and to Brant Skills Centre to communicate with Ontario Works regarding my referral to the
program. This information will be kept private and strictly confidential.
Client Signature: Date: _______________
Witness Signature:
Administrative Use Only
Date Referral Received (DD/MM/YYYY):
Date Application Received (DD/MM/YYYY):
Brant Skills Centre
Brant Skills Centre 225 Fairview Drive, Unit 1, Brantford, Ontario N3R 7E3
Phone: 519-758-1664 Fax: 519 -758-9394 Email: [email protected]
Website: www.brantskillscentre.org
Dear Applicant,
Thank you for applying to the Homeward Bound Brantford-Brant program. The Homeward Bound coordinator
will contact you to discuss next steps. She will use the phone number and/or email that you have provided in
your application. Please check your email regularly.
Due to the Covid-19 pandemic, the dates listed within this letter may have changed. Please contact the HWB Coordinator should you have questions.
All applications received by Friday, May 15, 2020 will receive equal consideration.
If you have not already done so, please register on OneList for fulltime childcare, and apply for childcare subsidy,
to be effective by September 2020.
Please provide us with a copy of your most recent transcript OR sign the transcript request form so we can
access it for you.
As part of the application process, you are expected to attend:
an information session
2 sets of assessments at Brant Skills Centre
Information Session dates will be scheduled during the dates listed below:
May 25-29
June 8-12
Assessments will be scheduled during the dates listed below. Each set of assessments require up to 3 hours to
complete:
June 15-19
June 22-26
Candidates that successfully advance through the application process will be invited for an interview between
July 6 and July 24.
Please arrange childcare well in advance for the dates listed above.
For more information, please contact:
Dione Winter
Homeward Bound Coordinator
Brantford-Brant
519-758-1664
Brant Skills Centre
Homeward Bound Brantford-Brant Application To be filled in by the applicant herself
1
Applicant Information
First Name: Last Name:
Date of Birth: mm dd yyyy
Home Phone:
Email:
Cell Phone:
Address:
City:
Apt. #:
Postal Code:
Is this housing:
Market rate rental
Subsidized rental
Other:
Shared with others Eg. Roomate
Marital Status:
Single
Married or Common Law
Separated
Divorced
Widowed
Other:
Citizenship Status:
Canadian citizen
Permanent Resident
Convention refugee
Other:
Current Source of Income (please check all that apply):
Ontario Works
Employment Insurance
Support Program (ODSP)
Child or Spousal Support Payments
Total Annual Gross Income (all sources):
Child Tax Benefit
No Income
Employment
Other:
Homeward Bound Brantford-Brant Application To be filled in by the applicant herself
2
Family Information
Number of children:
Number of children under the age of 17 in your legal custody and living with you:
Child # 1
First Name: Last Name:
Gender: Current Grade Level:
Date of Birth:
Day care: Child care subsidy:
Required Already have N/A Required Already have N/A
Child # 2
First Name: Last Name:
Gender: Current Grade Level:
Date of Birth:
Day care: Child care subsidy:
Required Already have N/A Required Already have N/A
Child # 3
First Name: Last Name:
Gender: Current Grade Level:
Date of Birth:
Day care: Child care subsidy:
Required Already have N/A Required Already have N/A
Comments:
Homeward Bound Brantford-Brant Application To be filled in by the applicant herself
3
Education & Skills
Highest level of education completed?
9
10
11
12 or OAC
GED
Post-secondary (please specify):
Country where educated:
How long have you been out of school?
Less than 1 year
1-3 years
4-6 years
More than 6 years
What were your reasons for leaving school?
Quit
Expelled
Completed/Graduated
Other (please explain):
How would you rate your computer skills? 1 is not very good and 5 is excellent. Please circle.
Word 1 2 3 4 5
Excel 1 2 3 4 5
PowerPoint 1 2 3 4 5
Access 1 2 3 4 5
Email/Outlook 1 2 3 4 5
Internet 1 2 3 4 5
Please list any training, licences, or certificates that you have completed or obtained: (i.e. computer classes, cooking, sewing, driver’s licence, apprenticeships, etc.)
What form of transportation will you be using:
Public Transit Vehicle Other _____________
Which of the following college programs interest you?
Early Childhood Educator (ECE)
Practical Nursing
Health Office Administration
Social Service Worker
Business
Other (please explain):
Please list your top three program choices in order of preference.
1. 2. 3.
Homeward Bound Brantford-Brant Application To be filled in by the applicant herself
4
Employment
What is your current employment status: Employed
Unemployed
Last or Current Employment (please also submit your resume with this application):
Company:
Title:
Start Date: End Date:
Reason for leaving: Quit Fired Other:
Comments:
Describe your greatest concern about the transition back to work and school? What do you think will be your greatest challenge?
Please check any of the following professional traits you think you may possess:
Good time management
Team player
Independent thinking
Flexible
Hard working
Good communication skills
Professionalism
Lifelong learner
Versatile
Articulate
Goal-oriented
Good planner
Organized
Good at multi-tasking
Other:
Please give an example of how you have applied one of the traits above:
Homeward Bound Brantford-Brant Application To be filled in by the applicant herself
5
Do you wish to identify any of the following as potential barriers to completing a post-secondary program and obtaining employment:
Interpersonal skills
English (ESL)
Attendance/Punctuality
Grooming
Motivation
Numeracy
Literacy Employment record
Education
Housing
Day care/Child care
Problems with authority
Have you ever been convicted of a criminal offence for which a pardon has not been granted?
Do you wish to identify any additional concerns?
What do you know about the Homeward Bound program? How does it align with your interests?
What would you bring to the program as a particpant?
Homeward Bound Brantford-Brant Application To be filled in by the applicant herself
6
Goals
Identify goals for the next:
Six Months
/personal/
1. _________________________________________________________________________________
2. _________________________________________________________________________________
3. _________________________________________________________________________________
/professional/
1. _________________________________________________________________________________
2. _________________________________________________________________________________
3. _________________________________________________________________________________
Two Years
/personal/
1. _________________________________________________________________________________
2. _________________________________________________________________________________
3. _________________________________________________________________________________
/professional/
4. _________________________________________________________________________________
5. _________________________________________________________________________________
6. _________________________________________________________________________________
If accepted into the Homeward Bound program, what are your expectations?
Brant Skills Centre
Brant Skills Centre 225 Fairview Drive, Unit 1, Brantford, Ontario N3R 7E3
Phone: 519-758-1664 Fax: 519 -758-9394 Email: [email protected]
Website: www.brantskillscentre.org
Consent for Brant Skills Centre to Access Transcript from GELA
I, ___________________________________(please print), give permission to Brant Skills Centre
to request my high school transcript from Grand Erie Learning Alternatives (GELA) on my behalf
for the purpose of completing academic assessments.
The last high school I attended was: ________________________________________________
The last year attended if known: eg. 2004____________________________________________
Date of Birth (DD/MM/YYYY): _____________________________________________________
Signature: _____________________________________________________________________
Date signed (DD/MM/YYYY): ________________________
Administrative Use Only
Date Consent Received by BSC (DD/MM/YYYY):
Brant Skills Centre