Girls Link Up Interest Form

2023-2024 School-Based Mentoring Program

Girls Link Up is a mentoring program for girls that supports their social and emotional needs while exposing and empowering them to S.T.E.A.M. college and career pathways. Girls Link Up works to bridge the gap between women and STEAM through engagement and exposure.
Student's Name*

First NameLast Name
Current School Grade*
We only accept girls in 3rd - 8th grade.
Current School *
Date of Birth*

MonthDayYear
Age:*
Student ID Number
Girls Link Up on the Weekend

In addition to our school-based mentoring program, we want to create weekend experiences for the girls in the Metro Atlanta area that may or may not be located at one of our school-based sites. This is an opportunity for all girls to meet new peers, learn something new, and get exposure to new opportunities. These meet ups will occur on the 3rd Saturday of every month.
Please select all that you may be interested in attending.

Girls Link Up Family Reunion - September 16thGirls Link Up for Breast Cancer Awareness - October 21stGirls Link Up for College - November 18thGirls Link Up for the Holidays - December 16th

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Home Phone Number

Area CodePhone Number
Business Phone Number

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail*
Mom Circles

Mom Circles is an outreach program that is committed to equipping, empowering and educating mothers in the community with resources to support their social and emotional needs.
Are you interested in learning more about our Mom Circles Program?*

YesNo
Media Release Statement - Funding sources may require footage and evidence of program execution. Meetings may be recorded periodically. 1) I, the undersigned, authorize 3D Girls, Inc. to photograph, take motion pictures, take video footage, and/or make electronic sound recordings (herein referred to as photographic or electronic reproductions). 2) I authorize the use of any such photographic or electronic reproductions for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by 3D Girls, Inc. (I understand that I may be identifiable from such photographic or electronic reproduction)
*

I HEREBY GIVE consent to the collection and use of my child’s personal images by photography or video recording.I DO NOT give consent for 3D Girls, Inc. to collect and use my child’s personal images by photography or video recording.
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2023-2024 School-Based Mentoring Program