Member Application
Partners in Change (PIC) can pair you with a trained volunteer coach for one-year, to be a supportive partner as you pursue your own goals to move your life forward.

PIC welcomes applicants with household incomes less than $50,000 and holding no more than a bachelor's degree.

As a volunteer PIC Member, I would:

     - Be partnered at no cost with a PIC Life Coach and commit to our partnership for one year.

     - Commit to connect weekly with my Coach for 30-45 minutes (by video, phone, or in-person, when safe).

     - Recognize that our partnership is focused on supporting me as I build my problem-solving skills and take steps to achieve my goals.

     - Consider becoming a volunteer PIC Coach myself at the end of my year of coaching, to be able to share my skills and knowledge with others.

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Email *
First Name *
Preferred Name
Middle Name
Last Name *
Name of program or school that referred you to Partners in Change: *
If you have children under 18 in your home, please share how many and any school(s) they attend.
Place of employment, if applicable:
Other volunteer or civic associations:
Check all that best describes you. *
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Gender *
Preferred Pronouns
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Age *
Your Birthdate *
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Street Address *
City *
State *
Zip Code *
Time Zone (please choose your time zone) *
Cell *
Emergency Contact Name *
Emergency Contact's Phone *
A goal I would like to pursue: *
Do you have a strong preference for a Male or Female Coach? *
I have continuous internet and phone access: *
How did you find out about Partners in Change? *
I have attended a Partners in Change interest session/orientation. *
What is your t-shirt size? *
By typing my full name & date below, I state the information above to be true and correct.
Full Name *
Date *
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