Pre-Qualification

Please answer the following questions honestly and completely. These responses will help determine your initial eligibility.

First Name

Last name

Phone Number

Mailing Address

Optional

City

State

Zip Code

Have you ever been convicted of a crime?

Yes No

Do you currently have any pending criminial charges?

Yes No

Do you have the total program fee of $11,500 for one year, which includes a $1,500 application fee and a $10,000 investment fee?

Yes No

Do you have a valid passport?

Yes No

Do you speak English?

Yes No

Do you speak French?

Yes No

What best describes your work experience or background?

Skilled trades (electrician, plumber, carpenter, mechanic) Professional (healthcare, Teachers, IT, business, lawyer, Engineer,) Agricultural or farm work Hospitality, housekeeping, maid, general cleaning Construction or general labor Retail, sales, or customer service Truck Driver other transportation services Security or facilities support Retired Student or recent graduate Other

Will you be financially responsible for covering your personal in country living expenses, including daily meals, cell phone service, local transportation, and related costs, for up to one year?

Yes No

How soon will you be ready to move to the host country?

Right away (within a few weeks) Within 1 to 3 months Within 3 to 6 months

A New Beginning for Haitians.
A Global Movement for Dignity.

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9841 Washingtonian Blvd, Suite #200 Gaithersburg, MD 20878

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Corporate Headquarters:

9841 Washingtonian Blvd, Suite #200 Gaithersburg, MD 20878

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