Brazen Table

Foundations Virtual Program

Participant Application

Thank you for your interest in the Brazen Table virtual program. Please fill in the application below. We look forward to hearing from you and will be in touch soon. If you have been referred by another organization, please be sure that organization has also filled out a Referral Form on your behalf.

Brazen Table - Foundations Participant Application

Program Details

What you get

  • An 8-week interactive learning environment; self paced within each week.
  • Weekly group check-ins and 1 hour case management sessions
  • All workbook materials printed and in an organized format
  • All non-perishable food materials provided to participant
  • A gift card to a preferred grocer
  • Essential equipment kit provided
  • ServSafe Food Handler’s Certification

General Information

Race and/or Ethnicity (check all that apply) *
I agree to receiving texts or calls directly related to the program: *
Do you have documentation that allows you to gain employment in the United States? *
What income bracket does your household fit into? *

Emergency Contact

This should not be your case manager.

Referral Agency

How often do you communicate with your case manager?
Please check all types of support or services you receive from this organization:

Housing + Access

Will you have a consistent place to sleep during the program? *
What is your current living situation? *
Where you are living, do you have access to a kitchen with the following features: *
For the program length will you have access to a stable internet connection? *
What type of device will you be using to access the classroom, attend meetings, and to turn in materials? *
Do you have a way to get to and from this grocery store on a weekly basis? *

Programmatic Questions

Do you have any dietary restrictions?

Educational History

Please list any of the schools you attended.

Include name + city

Employment History

Please list any work experience in the following charts. Start with the last job you held.
Add Remove
Do you have a disability that limits your employment activities? *
(Examples: mental illness, physical disability, substance abuse, developmental or learning disability, etc.)

Legal History

Would you be willing to submit to a background check so we can help you prepare for the employment process?

Personal Goals + Expectations