Found in Translation - Program Application
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Found in Translation - Program Application Completed applications should be mailed to: Found in Translation P.O. Box 560052 Medford, MA 02155 If you have any questions, please contact Maria Vertkin at maria@found-in-translation.org Are you a woman? ⟰ Yes ⟰ No (ineligible for this program) Are you eligible to work in the United States? ⟰ Yes ⟰ No (ineligible for this program) Are you fluent in English and another language? ⟰ Yes ⟰ No ⟰ Not sure (ineligible for this program) Contact Information Name: _____________________________ Address: ______________________________ Phone: _____________________________ ______________________________ Email: _____________________________ ______________________________ Languages My first language is _________________________ How well do you speak in this language? _________________________ How well do you read and write in this language? _________________________ My second language is ______________________ How well do you speak in this language? _________________________ How well do you read and write in that language? _________________________ Add any other languages you can speak, read, or write: Language: _________________________ Language: _________________________ Language: _________________________ Language: _________________________ ⟰ Speak ⟰ Speak ⟰ Speak ⟰ Speak ⟰ Read ⟰ Read ⟰ Read ⟰ Read ⟰Write ⟰Write ⟰Write ⟰Write Availability Daytime Evening ⟰ Mon ⟰ Mon ⟰ Tue ⟰ Tue ⟰Wed ⟰Wed ⟰ Thur ⟰ Thur ⟰ Fri ⟰ Fri ⟰ Sat ⟰ Sat ⟰ Sun ⟰ Sun Questions 1-7 are about your income and housing status. These questions must be answered completely in order for you to be considered for this program. 1. How many people are in your household, including yourself? _______ Please provide the following information for all household members, including yourself: Name: Age: Relationship to you: Employed? ____________________________ ____ _________Self__________ ⟰ Yes ⟰ No ____________________________ ____ ______________________ ⟰ Yes ⟰ No ____________________________ ____ ______________________ ⟰ Yes ⟰ No ____________________________ ____ ______________________ ⟰ Yes ⟰ No ____________________________ ____ ______________________ ⟰ Yes ⟰ No ____________________________ ____ ______________________ ⟰ Yes ⟰ No ____________________________ ____ ______________________ ⟰ Yes ⟰ No ____________________________ ____ ______________________ ⟰ Yes ⟰ No 2. Income in the last 30 days: 3. Earned income $_______ Unemployment Insurance $_______ SSI $_______ Disability Insurance $_______ SSDI $_______ Alimony or Child Support $_______ TANF $_______ Gifts $_______ Retirement income $_______ Other: ________________ $_______ What is your typical total household income (usually)? $_________/month ***Note: You will be asked to show evidence of your total household income (for example: pay stubs, employment verification, or tax returns) 4. Non-cash benefits you currently receive: ⟰ Food Stamps/SNAP ⟰WIC ⟰ SCHIP ⟰ Veteran Services ⟰ TANF Transportation ⟰ TANF Childcare ⟰ Other TANF Services ⟰ Medicaid (MassHealth) ⟰ Medicare ⟰ Section-8 ⟰ Rental Assistance ⟰ Fuel Assistance ⟰ Other: ______________________ ⟰ Public Housing 5. Have you experienced homelessness? ⟰ Yes, currently ⟰ Yes, in the past ⟰ Never 6. What is your current housing situation? ⟰ Emergency Shelter ⟰ Transitional Housing ⟰ Permanent Housing ⟰ Hotel or Motel ⟰ Staying/living with Family ⟰ Staying/living with friend(s) ⟰ Rental with subsidy ⟰ Rental, no subsidy ⟰ Own a home ⟰ Other: ______________________________________ ⟰ Section-8 or Public Housing 7. Describe any financial hardships you are experiencing: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Questions 8-11 are about your educational and professional development. These questions help us to understand your individual learning needs so that we can provide you with the right tools and supports for you to succeed. 8. What is your highest level of education completed? ⟰ No formal education ⟰ 1st-8th grade ⟰ Some high school ⟰ High School or GED ⟰ Some College ⟰ Associate’s Degree ⟰ Bachelor’s Degree ⟰ Master’s Degree ⟰ Doctorate or PhD ⟰ Certificate: __________________________ ⟰ Other: _____________________ 9. What kind of a learner are you (your learning style, strengths, and difficulties/challenges)? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 10. Do you have a resume? ⟰ Yes ⟰ No 11. Please provide the following information for all current and past employment, including paid positions, internships, and volunteer positions: Employer: ___________________________ Position: _______________________________ Duties/responsibilities: ___________________________________________________________ Hours/week: _____ Wages/Salary: $____________ Start date: ___/___ End Date: ___/___ What did you like most about this position? __________________________________________ What was most difficult about this position? __________________________________________ Why did you leave this job? _______________________________________________________ Employer: ___________________________ Position: _______________________________ Duties/responsibilities: ___________________________________________________________ Hours/week: _____ Wages/Salary: $____________ Start date: ___/___ End Date: ___/___ What did you like most about this position? __________________________________________ What was most difficult about this position? __________________________________________ Why did you leave this job? _______________________________________________________ Employer: ___________________________ Position: _______________________________ Duties/responsibilities: ___________________________________________________________ Hours/week: _____ Wages/Salary: $____________ Start date: ___/___ End Date: ___/___ What did you like most about this position? __________________________________________ What was most difficult about this position? __________________________________________ Why did you leave this job? _______________________________________________________ Employer: ___________________________ Position: _______________________________ Duties/responsibilities: ___________________________________________________________ Hours/week: _____ Wages/Salary: $____________ Start date: ___/___ End Date: ___/___ What did you like most about this position? __________________________________________ What was most difficult about this position? __________________________________________ Why did you leave this job? _______________________________________________________ Employer: ___________________________ Position: _______________________________ Duties/responsibilities: ___________________________________________________________ Hours/week: _____ Wages/Salary: $____________ Start date: ___/___ End Date: ___/___ What did you like most about this position? __________________________________________ What was most difficult about this position? __________________________________________ Why did you leave this job? _______________________________________________________ Starting a new career is never easy, and the Found in Translation training program is intense and a very serious commitment. Questions 12-15 are your opportunity to show to us that are ready to take on this enormous challenge. 12. Why do you want to become a medical interpreter? What motivates you? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 13. Why do you think you will be a good medical interpreter? What strengths and personal qualities do you think you can bring into this profession? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 14. Tell us about a time when you decided to do something big in your life and succeeded in getting it done. How did you achieve success? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 15. Tell us about a time when you did not succeed. Looking back, was there something you could have done differently? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ I certify that the information I have provided in this application is true to the best of my knowledge. Signature: ______________________________ Thank you for applying!
