* 2026 Participant Intake Form

Participant Intake Form

Dress for Success Greater New York City
Thank you for your interest in Dress for Success Greater New York City. We look forward to providing you with best in class services across our 4 pillars of work.

Here you will see our GOALS:
Here you will see our suite of services and offerings. Depending on your current position on your career pathway, we will work alongside of you to determine the best services for you.
Are you:*

A Partner Referring a Woman for ServicesA Woman Requesting Services
Name of the Referral Partner Agency or Organization.
Name of the Referral Partner
Email Contact for Referral Partner
example@example.com
Client First Name*
Client Last Name*
Client Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client Ethnicity/Race:*

WhiteBlack / African AmericanAsianAmerican Indian / Alaska NativeNative Hawaiian or Pacific IslanderMiddle Eastern / North AfricanHispanic / LatinoTwo or More RacesOther
Please select the category for the client's age:*

18-2425-3435-4445-5455-6465+
Client Phone Number*
Please enter a valid phone number.
What is your CURRENT employment status:*

Employed FTEmployed PTRecently Unemployed (Unemployed within the last 3 months)Longer Unemployment (Unemployed more than 3 months)I am a Student.I have an Internship
Reason for Client Appointment. Please select ONE of the following options:*

I have confirmed new employment.I have a confirmed interview scheduled.I have a confirmed internship starting soon.I have an upcoming Job FairNone of the Above
Would the client like to participate in a mock interview session (30 minutes) immediately following your styling appointment?*

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

Career Building (Mock Interviewing, Resume Review, Job Searching Etc.)Professional Networking (Opportunities to build your professional network and make new connections.)Women In the Workplace (Opportunity for women to meet with like minded peers and discuss important topics related to workforce success.)Financial Literacy 1:1 CoachingTopic Specific Workshops: (Professionalism in the Workforce, Work Life Balance)Health and Wellness Cohort Learning (A peer to peer and expert infused learning opportunity focused on health and wellness education.)I am not interested in Career Services at this time.
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.*
I consent to receiving communications via email, text, or phone calls from Dress for Success Greater New York City.

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

Cancelof
REQUIRED: Please upload your current Resume.

Cancelof
Please upload the following TWO document:

1) A confirmation of your internship, interview, career fair, or employment 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.*

Cancelof
I need to get my CONFIRMATION to upload:

Do you need time to get confirmation of your interview/internship or employment? 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.
Should be Empty: