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Middle Name

Last Name

Email Address

Phone

Street Address

City

State/Province

ZIP / Postal Code

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Identify as (check one):- Female- Male- Non-binary

Are you 21 years or older?- Yes- No

Do you live in Washington State?- Yes- No

What is your status? (check one):- Immigrant- Asylee- Asylum seeker- Refugee

Status Verification (proof of immigrant, asylee, asylum seeker, or refugee status)

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Income Verification (recent tax return or two pay stubs) - If there's more than one income in the home, include partner's tax return

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Proof of ID (must be 21 years or older)

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Proof of address. Bills and any other documents showing your name and address. (Washington State residency)

No file chosen

Do you have a driver's permit?- Yes- No

How much do you know about driving?- ⁠I have never driven before.- ⁠I have some knowledge, but ⁠I've never driven on my own.- ⁠I have driven with supervision (e.g., with a driving instructor or licensed driver)- ⁠I have driven on my own, but I don't have a license- ⁠I have a lot of driving experience and knowledge

Why don't you drive now?

Do you own a car?-Yes-No

How do you usually travel?

What is your level of education?

What language do you prefer for translation services? (check one):- French- Spanish- Portuguese- Lingala- Swahili- Arabic

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Spreading Christ’s love and serving the community with compassion and faith.

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thewordoflife.laborne.wa@gmail.com

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University Place, WA 98466

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