Apply – ECHO

Thank you for your interest in Breaking Ground. Complete the short form below and someone from ECHO will be in touch with you about the next available cohort. Questions? Contact Kia Troupe at ktroupe@echotlh.org or (850) 224-3246, extension 206.

Breaking Ground - Interest & Application

Interest form for prospective Breaking Ground cohort participants. Contact: Kia Troupe, ktroupe@echotlh.org, ext. 206

About You

Full Name(Required)

First Last

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Date of Birth(Required)

Your Household

Children living with you

Name

Age

Employment & Transportation

Current of most recent place of employment

If currently unemployed, write "currently seeking work."

Do you have access to reliable transportation?(Required)

Yes

How You Found Us

How did you hear about Breaking Ground?

Is there anything you'd like us to know before we reach out?

This is optional — share as much or as little as you'd like.

Breaking Ground participants are expected to commit to attending all 15 weekly sessions over four months. Sessions are held at ECHO's Educational Building, 548 E. Bradford Road. Each session is approximately two hours. Space is limited.

I understand the attendance commitment and would like to be considered for the next cohort.