ECONOMIC EMPOWERMENT PROGRAM APPLICATION
Our Norwalk’s Economic Empowerment Program is a hands-on, financial literacy, digital skills, professional development and career training program designed to assist women in the community.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Pronouns
*
Do you identify as transgender?
*
Yes
No
Decline to answer
Please select race(s) and ethnicity(ies) that you most closely identify with:
American Indian or Alaska Native
Asian
Black or African-American
Middle Eastern or North African
Caucasian
Latinx or Hispanic
Native Hawaiian or Pacific Islander
Decline to answer
Other
Where did you hear about this program? If you were referred by another agency or organization, please list the name of the organization and the name of the person who referred you.
*
Education Level
*
Less than a high school diploma
High school diploma or equivalent
Some college
Bachelor’s degree
Masters or higher
Employment Status
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Full time
Part time
Self-employed
Unemployed
Other
If employed, please list your job, title and hours you work per week
*
Do you receive government assistance?
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Yes
No
Decline to answer
How would you describe your digital literacy (computer) skills?
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Beginner
Intermediate
Advanced
Can you commit to attending the entire 8 week program? (one time per week, 2.5-3 hours)
*
Yes
No
What if any supports do you need to commit to attending the entire program (i.e. childcare, transportation assistance)?
*
What do you hope to gain from participating in this program?
*
Terms & Conditions
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I understand that this application is for admission only for the term indicated. I understand that applying for this program does not guarantee acceptance. I certify that this information is complete and accurate. If admitted, I agree to abide by the policies of YWCA Darien Nowalk’s EEP and the rules and regulations of YWCA Darien Norwalk. Should any information change prior to my entry into YW Strive, I will notify YWCA Darien Norwalk.
Photo Release
I hereby grant YWCA Darien/Norwalk permission to photograph or record my image and use it for marketing and promotional purposes, including but not limited to social media, the organization's website, and other marketing materials. I understand that these images may be publicly accessible and grant the organization full rights to use them accordingly.
Please verify that you are human
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
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