Prosperity Community Outreach, Inc.

Empowering today's youth to become tomorrow success stories

Social Services

Prosperity Community Outreach, INC

A Non-Profit Organization

425 Aldine Bender ste.C

Houston, TX 77060

281-448-5700

www.prosperitycommunityoutreach.com

 

 

Hoilday Season Client Intake Form

 

Name: _________________________                 Spouse Name: _______________________

DOB: _______                                                        DOB:  ________

Male___ Female___                                             Male___ Female___

Address: ______________________________________________________________

Phone: ________________________________________

             This number must be a valid contact number / Este número debe ser un número de contacto válido

Last 4 of SS#: ___________________________________________

Email: __________________________________________

 

# of children ___       # of people in household ___

#de niños                   # de personas en el hogar

 

 

Children  Names                                Ages           Birthday                         Grade level

Los nombres de los niños           de edad      de cumpleaños             nivel de grado    

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

 

Annual Household Income: _________

Anual ingresos de hogares

 

Would you like to be added to our mailing list for future assistances?  Yes__or No___

¿Le gustaría ser agregado a nuestra lista de correo para asistencias futuras?

Testimonials

  • "I would love to thank PCO for the time they took with me and helpfully getting me situated in college. Without the help of the processing of my financial aid, that PCO helped me..."
    Dominique Jones
    Satisfied student
  • "Thanks PCO, for helping me get started, at my age, I did not know where too begin until I contact PCO.....Mrs. Mingo sat and explain too me POINT A too POINT B......all of my pa..."
    Charita Lott
    An Ole Schooler Trying too get in School