About Us

1145 Washington St | Boston, MA 02118 | Tel: (617) 542-3740 | Fax: (617) 542-3860

Any information we ask on the application is used to help us to best support you in obtaining employment.
It is important to complete all sections of this application. An incomplete application will not be considered.
All information you provide on this application is considered confidential. Criminal history will not disqualify you from our services.

Project Place does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.

-Client Section-

Demographic Information

Technology Skills

  1. No Confidence - I don't know what a
    smartphone is but I am excited to learn!
  2. Very Little Confidence - I can make a phone call but I can't send an email
  3. Somewhat Confident - Sometimes I can send emails but I can't figure out how to log in
  4. Pretty Confident - I manage to use the
    computer to get tasks done but I still have
    things to learn
  5. Very Confident - I was an IT specialist
    before, but I always can learn more

Employment Information

Physical and Mental Health

Housing History

Legal History

Criminal history will not disqualify you from our services.
As a part of our programming, Project Place will run your CORI at no cost to you.
Your case manager will assist you with supports and services related to you CORI.

Personal Information

PLEASE fill out these questions keeping your future goals, both personal and professional, in mind.

Finally, list up to 3 backup contacts for us to call should we be unable to reach you about your appointments

Person 1

Person 2

Person 3