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 Selection

There are two options to engage in Brazen Table: Foundations. Which option are you applying for?

Team-Based Programming

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

Self-Led Programming (coming soon)

  • Participant has 6 months to complete programming
  • Upon completion, participant has access to materials for life
  • A referral is required for participation
  • Participant must attend a 1x/month virtual check-in until programming is completed
  • Client has access to all of the same digital lesson materials
  • All lessons are posted upon sign in
  • ServSafe Food Handler’s Certification
  • Equipment and gift cards are not provided for the self-led programming
Programming Choice *

General Information

Race (check all that apply) *
I agree to receiving texts or calls directly related to the program: *
Are you legally entitled to work 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:
Do you feel as if these services are helpful to you?

Housing + Access

Will you have a secure place to live 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 (April 12th-June 4th) 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

Personal Goals + Expectations