2025 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.None of the Above
For Client Only (Please complete as part of the intake process.)
Would the client like to participate in a mock interview session (30 minutes) immediately following your styling appointment?*

YesNo
How confident are you in your ability to achieve your career goals?

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Rate your ability to plan for career advancement.

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How confident are you in making career related decisions.

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Rate your satisfaction with your ability to manage your personal and professional life.

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How strong is your professional network?

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How visible are you in your professional community?

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Do you have adequate access to career opportunities?

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How motivated are you to advance in your current or desired career pathway?

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How respected do you feel in your current work environment?

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How likely are you to participate in professional development activities.

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Do you have access to an inspiring role model at work or within your industry?

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

Cancelof
REQUIRED: Please upload your current Resume.*

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I need to get my CONFIRMATION to upload:

Do you need time to get confirmation of your interview/internship or employment? Click the 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 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:

Participant Intake Form

For Client Only (Please complete as part of the intake process.)