FSP Adult Application

FSP Adult Application

INSTRUCTIONS

APPLICATION FOR MINOR(S)

First complete the FSP ADULT APPLICATION below.

Upon completion of this application, a confirmation email from "Smartsheet" will be sent to the email you provided. This email will include your APPLICATION CODE, which you will need to complete the FSP MINOR APPLICATION for each child that will be enrolling in the program with you.

When you complete this application, you will be rerouted to our website where you can submit the FSP MINOR APPLICATION.

FSP REFERRAL FORM

Please have your Referral Point of Contact complete the FSP REFERRAL FORM also located on our website themauifarm.org/programs

Family Strengthening Program Overview

The Family Strengthening Program is a farm-based residential program providing transitional housing and life skills training for families who are homeless or at risk of homelessness due to domestic violence. The Maui Farm provides services after emergency shelter services have been maximized, and before families move on to long-term housing in the community.

While enrolled in the Family Strengthening Program, participants will be focused on achieving outcomes related to transition to housing, gainful employment, verifiable income, securing adequate childcare, positive parenting, and self-advocacy. The Family Strengthening Program is an intensive program that supports participants in reaching goals described above on an accelerated timeline as a result of the support provided by the organization.

This application is used to determine eligibility and whether the FSP can offer your family the support and assistance you need. The questions in this application are included solely as a way of establishing whether this program is a good fit for your needs and situation. Determination of acceptance into the Family Strengthening Program (FSP) will be made on a case by case basis.

FSP Program Services

Participants in the Family Strengthening Program commit to participating in the following program services and activities:

• Meeting weekly with a Case Manager

• Pursuing a Family Transition Plan that details measurable goals, services, activities, and timelines.

• Participating in Community Garden, weekly garden activities for the whole family on the farm.

• Participating in Malama Pono’i (MPI), weekly women's empowerment classes.

• Participating in Ho'olana Keiki Education Program, educational activities and lessons for children.

• Participating in daily farm chores, such as animal feedings, animal husbandry, caring for the gardens and nursery, and special projects.

Date*

Name*

First & Last Name

Email*

Phone Number*

Date of Birth*

Applicant Age*

Sex*

Select

Referral Agency*

Select

Other Referral Agency*

Referral Point of Contact*

Name and title of the employee you are working with at referral agency

Identification*

Please choose the identification type

Select

Marital Status*

Select

Demographics*

Select

Other Demographics*

Where are you from?*

Where were you living prior to your current living arrangement?

Select

Other*

# of Children (Minors)*

Age and Sex of Children*

(Ex. 5 year old female, 9 year old male)

How many FSP Minor Application(s)?*

How many children will be residing with you at The Maui Farm?

**Please note that you will be required to fill out an FSP Minor Application for each child

Maui Wildfires*

Have you been affected by the August 2023 Maui Wildfires?

Select

If yes, please explain.*

Please explain how you have been affect by the wildfires. Be specific.

(ex. Lost your home, lost your job, etc.)

If accepted into the Family Strengthening Program, participants will need an immense commitment to openness to learn and apply new strategies in their life.

If you are willing to commit to the above, please check the box below:

Extending Your Knowledge*

Housing

Current Living Arrangement*

Select

Describe Living Arrangement*

Please describe your current living arrangement. Be specific.

Housing Status*

Is your name on any property or rentals?

Select

The ultimate goal of this program is that participants transition out of it. The expectations are that program participants will engage daily in their search for safe, adequate housing which includes, but is not limited to, applying and accepting all opportunities available.

If you are willing to commit to the above, please check the box below:

Housing Commitment*

Income Generation and Financial Management

Employment Status*

Select

Employment Type*

Please describe your current or most recent employment and employer

(ex. personal banker at Bank of Hawaii, waitress at Marlowe on the weekends)

Employment History*

Please describe your employment history below. Include company you worked for, position title and dates that you were employed for that company.

Education Level

Select

Disability*

Do you have any disabilities that require reasonable accommodation? If so, what accommodations do you need?

Legally qualified program participants will be facilitated daily in obtaining gainful employment and pursuing career growth.

Eligible participants are encouraged to apply for all assistance programs in which they qualify.

If you are willing to commit to the above, please check the box below:

Income Generation Commitment*

Monthly Income Amount*

Please provide your monthly GROSS income.

Source of Family Income*

Select

Other Income Source*

Please select all that apply.

Select

Non-Cash Benefits*

Please select all that apply

Select

Program participant's will work on monthly budgets to evaluate their financial position, expense accountability, and track financial goals. In order to practice this effectively, participant's engagement, cooperation, and transparency is essential.

If you are willing to commit to the above, please check the box below:

Financial Management*

Transportation

Select

Health Insurance

Select

Health Information*

Do you have any health conditions that we should be aware of? (ex. Bee allergy- requires EpiPen)

If none, type "None"

Legal Matters*

Are you currently involved in any open legal matters? (ex. TRO, custody, divorce, domestic violence, truancy)

Ohana Strengths and Values*

Please describe your 'ohana including strengths and values.

Anticipated Needs*

What challenges and needs do you anticipate for you and your 'ohana in the next 6 months?

Goals*

What do you think you can feasibly accomplish in the next 6 months?

Participation*

How will your participation in TMF's Family Strengthening Program support your goals?

Weekly Schedule*

What is your weekly schedule? Please include work, school, appointments, and all weekly commitments.

Questions or Comments

Any questions or additional information you would like to share?

FSP Agreements

The Maui Farm is a shared living environment and the following agreements are for the health and safety of all participants and staff on campus.

TB Clearance*

An up to date Tuberculosis Test clearance is required for all family members before entering.

Yes, I am willing and able to provide a TB clearance for me and my children residing with me

Non-Violent Parenting Commitment*

The Maui Farm does not allow violent parenting. This can include aggressive punishment, yelling, belittling, name-calling, or verbal/emotional abuse.

Yes, I can commit to non-violent parenting

Drug & Alcohol-Free Environment*

Drugs and alcohol of any kind are strictly prohibited.

Yes, I am willing and able to live in a drug and alcohol-free environment

DOCUMENTS CHECKLIST*

Please upload the documents below:

Drivers License or ID

Social Security Card

Most recent tax return or 2 months of paystubs

Divorce Decree or Legal Separation

TRO

Drag and drop files here or

**If you have any questions, please contact us at (808) 579-8271 or info@themauifarm.org**

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