ALLY APPLICATION
Circles of Greater Pittsburgh
Circle Allies are community members who want to be in a supportive, intentional, relationship with an individual or family working to get out of poverty. Circle Allies work with Circle Leaders to figure out how to accomplish their plan. You’ll walk side-by-side with the Circle Leaders challenging poverty, barriers, race, injustice and hope. And build new friendships along the way.
APPLY NOW
 
Where is your preferred /neighborhood site? *


 
What is your name? *

 
Age *

 
Address *

 
Cell Phone *

 
Home Phone

 
Place of Employment

 
Work Phone

 
Email address

 
Preferred Method of Contact

 
Select all the mornings which you are available *


 
Select all the afternoons which you are available *


 
Select all the evenings which you are available *


 
Primary Criteria of an Ally


 
Do you live at or above 200% of the Federal Poverty Guidelines (see chart below) OR are you financially stable if retired? *

     
 
Are you at least 18 years old? *

     
 
Do you speak and read English? *

     
 
Are you able to attend weekly classes or meetings? *

     
 
Are you motivated to learn and apply new ideas? *

     
 
Are you willing to build intentional relationships across class and cultural lines?

     
 
Does your family support and encourage involvement in Circles program? *

     
 
If you have a history of alcohol or other addiction, have you been in recovery for at least the past 6 months?

     
 
Are you relatively stable (ie., not currently homeless or dealing with domestic abuse)? *

     
 
Family Information


 
Do you have children? *

     
 
What are their names and ages?

 
Background Information


 
Summarize skills, qualifications, and or training you have acquired from employment, education, life experience or through activities, including hobbies or sports.  Passions and talents you would like to share with others.

 
List community/social/faith-based groups and organizations you are involved with that referred you or that you may be able to share with a participant.

 
How did you hear about Circles? *

 
What about being an Ally is of interest to you? *

 
What would you like a Circle Leader to know about you before being matched? *

 
What behaviors do you find most frustrating in people? *

 
I am really good at:

 
I am not so good at:

 
Have you ever been convicted of a felony? *

     
 
Currently have pending court cases? *

     
 
Any active warrants? If yes, please explain: *

(Note: Background Checks will be a requirement for participating in any activities where children may be present)
 
Who should we notify in Case of Emergency?

List their name, address, cell phone and home phone.
 
Agreement and Confidentiality Statement


 
As a participant of Circles I understand that I must ensure the confidentiality and privacy of all those who participate including Allies, volunteers, and staff.  I further understand that the fact an individual is served by Circles must be kept private and confidential, and at no time shall I disclose personal information that is shared in Circles. *

     
 
Thank you for your application!


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