Note:

Please fill out all fields in order for your application to be considered for membership. Incomplete applications will not be approved.

 


 

Other Resources

  • Snow Cap
    17805 SE Stark
    Portland, OR
    503-674-8785
  • Portland Adventist
    Community Services (PACS)

    11020 NE Halsey
    Portland, OR
    503-22-8500
  • Oregon Food Bank
    (Call for food assistance in your particular area)
    503-252-05555
  • Sunshine Division
    (For emergency food box)
    503-823-2119
  • 211 can provide free guidance and
    information about family resources

    Dial 211
    Text the keyword children to 898211
    Email children@211info.org
    Visit 211info.org

Note: All Fields are Required!

Personal Information

First Name:

Last Name:

Telephone:

Email Address:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Number of People in Your Family :

Answer Each Question


  1. Do you understand that this application does not guarantee participation?
    YesNo
  2. Have you read through the website and guidelines to fully understand the BCS program?
    YesNo
  3. Are you willing and able to pay a monthly service fee of $70?
    YesNo
  4. Are you willing and able to contribute two hours of volunteer time a month?
    YesNo
  5. Is at least one member in your household employed or seeking employment (this could be you)?
    YesNo
  6. Are you receiving SNAP (food stamps)?
    YesNo
  7. Are you receiving TANF (welfare)?
    YesNo
  8. Do you fluently speak English?
    YesNo
  9. Are you a previous BCS participant?
    YesNo
  10. If qualified and contacted by BCS, are you willing and able to participate in an intake session?
    YesNo
  11. I understand that the BCS program, although providing food, is primarily focused on helping working, struggling families become sustainable. This is achieved through regular interaction with our Sustainable Families Program Manager and financial mentors. I understand I will be asked to provide a current budget and income information, and am willing to discuss this information in detail and work through projected financial goals. I am willing to attend a financial training class, and am excited about making progress in eliminating debt and relieving stress in my life.
    YesNo

References

Personal Reference

First Name *:

Last Name:

Relationship to Applicant:

How long you’ve known him/her

Personal Reference's Telephone:

Personal Reference's Email:

Professional Reference

First Name *:

Last Name:

Relationship to Applicant:

How long you’ve known him/her:

Professional Reference's Telephone:

Professional Reference's Email:

 

Do we have your permission to contact your personal and professional references?
YesNo

How did you hear about BCS?

Why do you have a need for the BCS program?