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HEAL (Housing, Equity, Advocacy, & Leadership)

Program Application

To apply as a participant for HEAL, fill out this form below.  All fields are required.

You may also fill out the application in Spanish or Haitian Creole.

Please contact Mayra Cruz at MayraC@catalystmiami.org or (786) 527-2573 if you have any questions.

First Name

Last Name

Your Email

Your Phone Number

Address

City/State

Zip code

Birthdate (Month / Day / Year)
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Gender
FemaleMaleNon-Binary

Are you a parent or guardian of children that would be interested in the youth class (ages 4-13)?
YesNo

If yes, how old are the children and what are their names?

Are you a parent or guardian of a teen that would be interested in the adult class?
YesNo

If yes, how old are the teens and what are their names? They should also fill out their own separate application.

Are you in need of transportation?
YesNo

Employment
Full-timePart-time
Other employment:

Occupation

Highest Level of Education Completed
College DegreeSome CollegeDiploma or GED
Other: Highest grade completed:

Race/Ethnic Background
Black/African-AmericanWhite/CaucasianHispanicAsian/Pacific IslanderAfro-Caribbean
Other race/ethnic background:

Are you affiliated with any organizations?
YesNo
If yes, please name them:

Catalyst Miami's programs and services aim to prioritize those with an income that falls at or below the chart below. Given your family size, does your income fall at or below the amount on the chart below? Your answer to this question will not guarantee or prevent your participation in our leadership programming.

Family Size -- Income
1 ---- $47,440
2 ---- $54,240
3 ---- $61,040
4 ---- $67,760
5 ---- $73,200
6 ---- $78,640
7 ---- $84,080
8 ---- $89,520
YesNo

Briefly discuss an issue that concerns you most about affordable housing in our community (required)

What skills would you like to take away from our leadership program? What are your goals? (required)

Are there any challenges that would prevent you from completing the selected program? (required)

How did you hear about us? (required)

Thank you for your answers and your interest in participating in HEAL!

To be included as a program participant, you must successfully complete a selection process. Filling out this application does not guarantee acceptance into the program. Catalyst Miami will be in touch with you regarding next steps. Thank you!