* 2026 Participant Intake Form

Welcome

First let me say, "I am glad you are here!" The GNYC team specializes in providing you with the support you need to achieve econmic mobilty, career building skills, and the confidence you need both at work and at home. We are here to support you along your career pathway no matter where you are on your career journey. This intake for will help make sure we are providing you with the right service(s) at the right time. Please fill out ALL of the questions. Your information will be kept confidential.

Expanding Our Services and Reach

We are expanding our reach and services to women across Greater New York City. What brings you to Dress for Success? We provide professional styling services and career building services to the following populations:

Career Milesones
- New Employment
- Confirmed Interview
- Confirmed Internship or Career Fair
College Resources
- Graduation
- Presentations, Research
- School of Continuing Studies, GED
Housing Milestones
- New Apartment
- New Home
Health and Wellbeing
- Re-entry to community after In-Patient, Outpatient Psychiatric or Psychological Services
- Re-entry upon completion of Substance Uses Disorder Services (SUDS)
Immigration
- Lawyer Appointments, Court Appointments
- Citizenship Hearings
Veterans
- Re-entry to community after military service
- Employment/Interview after returning to community
Justice Involved Women
- Family, Criminal, Civil Court Appearances or Hearings
- Re-entry after incarceration

Let's Get Started.....

Are you:

What brings you to Dress for Success Greater New York City today.

Where did you learn about Dress for Success? (Select 1)

Name of the Referral Partner Agency or Organization. PUT N/A if this does not apply.

Name of the Referral Partner. PUT N/A if this does not apply.

Email Contact for Referral Partner. PUT N/A if this does not apply.

example@example.com

Referral Partner Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Client First Name

Client Last Name

Client Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Client Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Client Ethnicity/Race:

Please select the category for the client's age:

What is your CURRENT employment status:

How many people live in your household?

What is your household income?

In the past 3 months, have you received a certificate or diploma for your continuing education?

In the past 3 months, have you participated in a formal education program?

Reason for Client Appointment. Please select ONE of the following options:

Would the client like to participate in a mock interview session (30 minutes) immediately following your styling appointment?

Please select the career services the client is interested in receiving: (Check All That Apply)

REQUIRED: Please upload confirmation of your internship/interview or employment or job fair. (PDF, Screenshot, Email)

REQUIRED: Please upload your current Resume.

I have the skills I need to do the job I want. (0-Strongly Disagree | 10-Strongly Agree)

I feel prepared to take on new responsibilities at work. (0-Strongly Disagree | 10 Strongly Agree)

I feel confident in who I am, separate from my job title or employment status. (0-Strongly Disagree | 10 Strongly Agree)

I believe I bring value to any team or workplace. (0-Strongly Disagree | 10 Strongly Agree)

I feel confident making decisions about my next career step. (0-Strongly Disagree | 10 Strongly Agree)

I know how to evaluate a job offer and decide if it is right for me. (0-Strongly Disagree | 10 Strongly Agree)

I believe my own actions and effort make the biggest difference in my career outcomes. (0-Strongly Disagree | 10 Strongly Agree)

When something doesn't go my way at work, I look for what I can change rather than feeling stuck. (0-Strongly Disagree | 10 Strongly Agree)

I see myself as a professional in my field. (0-Strongly Disagree | 10 Strongly Agree)

I feel like I belong in professional workplace settings. (0-Strongly Disagree | 10 Strongly Agree)

I feel confident describing my skills and experiences to an employer. (0-Strongly Disagree | 10 Strongly Agree)

I know how to talk about my strengths in a job interview. (0-Strongly Disagree | 10 Strongly Agree)

If I don't get the job I applied for, I feel confident I can keep going and try again. (0-Strongly Disagree | 10 Strongly Agree)

I bounce back quickly from professional setbacks or rejection. (0-Strongly Disagree | 10 Strongly Agree)

Photo Consent: During your styling session we will be taking your photo and attaching it to your client record. Your photo may be used in promotional materials (i.e. social media, website, promotions, etc.) If you do not want your photo used, please inform your stylist or coach.

Opt In For Communications: I consent to receiving communications via email, text, or phone calls from Dress for Success Greater New York City.

Please upload the following TWO document:

1) A confirmation of your appointment. (This can be an email, screenshot, letter, etc.)

2) A copy of your CURRENT RESUME. We will not be able to schedule you for your appointment without these two documents.

Upload your CONFIRMATION AND RESUME.

I need to get my CONFIRMATION to upload:

Do you need time to get confirmation documents? Click the save button and copy the link for use at a later time. An EMAIL will be sent to the email address you provided. You can come back to your saved form and upload the documents.

I need to get my RESUME to upload:

Do you need time to upload a digital resume? Click the save button and copy the link for use at a later time. An EMAIL will be sent to the email address you provided. You can come back to your saved form and upload the documents.

Participant Intake Form

Welcome

Expanding Our Services and Reach

Workforce Development and Career Confidence Scales