WEEP Form

Women's Economic Empowerment Program Application

After you submit this application, we will review your eligibility for the Program. Most women are referred to enroll in a current or future class. We will reach out to you after review to let you know we have received your information. If you qualify, we will again reach out to you during the next open enrollment period to enroll you in an upcoming session. Enrollment typically occurs 2 weeks prior to each class, and class materials are available for pick up the week before class begins.
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
E-mail*
example@example.com
Phone Number*
What County do you currently live in?
What program(s) are you interested in?
What is your current employment status?
What is your highest level of education completed?
Check which best describes your race/ethnicity? (please check all that apply)*

White/European DescentBlack/African American (having origins in Sub-Saharan Africa)American Indian/ Alaskan Native (e.g. Aboriginal Australian, First Nations, Native American)Asian (e.g. Central Asian, East Asian, South Asian, Southeast Asian)Native Hawaiian or Other Pacific Islander (a person having origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands)Middle Eastern/North African (including the Middle East, North Africa and the Arab World)Prefer not to Answer
Ethnicity (please select one):*

Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)Not Hispanic or LatinoPrefer not to answer
Marital Status
Which gender to you most identify with?*
Communication Preference/Status (please select all that apply) **

EmailPhoneTextPostal Mail
Why are you interested in participate in the Women's Economic Empowerment Program?*
Please verify below. If you have any difficulties, please call 989-894-9055*
Should be Empty:

Women's Economic Empowerment Program Application