Car Repair Assistance Application

Before proceeding with this application, please first email a copy of your current, valid driver's license, a copy of your registration, and proof of current insurance to: transportation@pearlpromise.org

Please complete the entire application as failure to do so will automatically disqualify you for assistance. 

Please use n/a when applicable.

To qualify for services from PEARL for you or your child(ren), you must:

  • Be a single parent with at least 50% legal custody  to a child/children under 18 years of age
  • Reside in Boulder County (preference in services are first given to St. Vrain Valley School District Residents)
  • Be receiving some form of government or public assistance
  • Be motivated to become self-sufficient

Proof of eligibility and need will be required  (i.e. lease, bill, divorce decree, child custody agreement, birth certificate for children, etc.) Recipients must possess a valid driver's license and agree to provide insurance on the vehicle at time of repairs.

PEARL partners with auto repair business in the community to assist clients with vehicle maintenance and repairs.  This is done at our monthly Car Care Clinics and on an as-needed basis. 

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Email *
Today's Date *
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Full Name *
Current Address (Include City, State, Zip Code) *
Contact Phone *
Can you receive texts at the above number? *
Date of Birth *
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Please list the name and age of each child (under the age of 18) in your primary care. *
Are there any other adults (18 years of age and older) in the home?  If so, please list names/ages/relation, as well as contribution to the household. *
How did you hear about PEARL? Please list the person or agency that you were referred by. *
Please provide the year, make, model, mileage and VIN# for the car you are seeking repairs for. Also please state is car is owned, leased, or financed as well as the monthly payment. *
To the best of your knowledge, what are the specific repairs needed on your vehicle (i.e. I need an New Battery, Oil Change, Tire Rotation, Front End Alignment, Brakes, New Tires, Transmission Service, etc.) Please also supply any estimates you have been given. *
Is the car drivable? Please provide us with details of what is happening when you drive it (i.e. what sounds is it making, do you know what is  causing the sounds, have you taken your car to a repair shop, etc.). *
Will the car requiring towing to receive repairs and are you able to provide this? *
Do you have an alternate means of transportation while vehicle is being diagnosed or having necessary repairs performed? 
 *
What is your employment situation?  (Job title, employer, length of employment, number of hours per week, etc.) *
Are you currently enrolled in school?  If so, where are you enrolled and what are you studying? *
What public assistance benefits do you receive? *
Required
What other resources (non-government) have you received assistance from in the last 6 months? *
Required
List any education assistance you are receiving (Student loans, grants, etc.) *
List All Monthly Income. Please include salary, child support, Social Security, disability benefits, etc.) *
List All Monthly Expenses including rent/mortgage, utilities, phone, car payment, insurance, gas, food, medical expenses, etc. individually below. (Please label i.e. Rent - $1000, Utilities - $100, etc.) *
Are you currently a participant in any of our programs?  Please note, participation is NOT required to be a recipient.  Check all that apply. *
Required
Have you received any services from PEARL in the last TWO years? *
Required
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