Address, Phone, Name Change

Direct Deposit Enrollment

Emergency Contact Form

Employee & Supervisor Incident Report

Hepatitis B Vaccination Request

Participant Incident Report

Personal Leave Donation

Personal Leave Request

Purchase Request

Unpaid Leave Request

Vehicle Incident Report

W-4 (2019)

Apply for a Career Path Success Fund Basic Needs Grant

Are you attending school, working a low wage job, and/or pursuing an apprenticeship or certification?

Does your family need help with meeting basic needs?  You may be eligible for a Career Path Success Fund Basic Needs Grant!

Eligibility Criteria:

-Qualify as low income (Defined as 185% of Federal poverty line)

-Are expecting or have at least one child age 0-8

-Live in a rural area of Snohomish County

-Are seriously pursuing your career goals

Funds can be used for BASIC NEEDS for both children and adults in household

Examples of basic needs:

–Transportation–car repairs, bus passes, gas, auto insurance….

–Clothing, shoes, & gear needed for school or work

–Sanitation & Safety—septic or RV service, portable toilets, clean water, reflective gear, supplies & tools for a clean and clutter free living space….

–Nutrition—food, special diets, kitchenware, refrigeration, fuel….

–Housing—utilities, bedding, rental deposits, home repairs & more

Career Path Success Fund Application

Please send completed application to mdietz@villagecommunitysvcs.org (electronic signatures ok).  Questions? Call 360-653-7753 ext. 14.

The Career Path Success Fund is funded by a grant from the United Way of Snohomish County.