Mentorship Program

Hey there! Please read. Thank you so much for being brave enough to take the first step and ask for help. We are so happy that you want to be apart of our sisterhood, and just need a few important details before we can add you to the waitlist. Mentorship is offered on a first come-first serve basis, so the sooner you submit this application, the quicker you will be eligible for the program.

You must complete this form in detail and in its entirety in order to be eligible for our program. Once we receive your form, if you haven't already spoken with a staff member, you will receive a text or email. Please allow 7 business days for your application to process.

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.

Birthday

Date

How did you hear about this program?

Tell Us Your Story.

What resources do you need?

Dorm style HousingDiapers and WipesTrade School Enrollment Support (CNA, Phlebotomy, etc.)College Enrollment (IT, Nursing, Teaching)Job PlacementMental Health Support/TherapyMonthly Mommy Meetups/Support System

Other:

Do you have a therapist?

Have you graduated from high school? If so, what year? If not, do you want to get your GED?

Have you ever started or finished college or any type of certification/license? Please explain.

Where do you see yourself in 5 years with our support? What do you want to have accomplished?

If we pair you with a mentor/"big sister", what would you like to achieve from that relationship? (Example: financial goal setting, someone to talk to, someone in your career field, etc.)

Do you have/need help with any of the following?

If the answer is yes, do you need a referral for therapeutic support?

Is your mom or dad in your life? Explain.

Are you pregnant?

YesNoUnsure

If so, when are you due?

Is your child's father in your life? Explain.

How many children do you currently have? What are their names and how old are they?

What size diapers do you need? Feel free to put n/a if you do not need diapers.

Besides diapers and wipes, what other supplies would you like to see in our diaper pantry?

Do you have a support system? Explain.

Do you or your child have any health issues? If so, please explain.

Do you have a current or past history of substance abuse? If so, please explain.

Do you have child care?

The next few questions will be personal and will give us a better idea of your financial situation. There is no right or wrong answer. We are using this information to figure out what resources you will need. Upon enrollment to the program, we will ask you to share your financial documents so that we can help you with budgeting and saving.

Do you receive any financial aid or government benefits? If so, explain what you receive and how much. (EBT, WIC, etc.)

Do you have a savings? How much do you have in savings currently.

How much do you currently have in cash or in your checking account? (Dollar amount)

Do you have a job? If so, where do you work and how much do you make per hour and per year? Is it full-time or part-time?

What other sources of revenue do you have? (For example, child support)

Upload a picture of you and baby. Please note you will also be asked to meet with us in-person and provide drivers license, passport, or another form of picture identification upon successful enrollment in the program, so please use a real photo. {If pregnant, you + baby bump counts!}You can also send the picture to me (Gigi) at 667-328-0060. Your application will not be processed until this form is completed in its entirety and all attachments are submitted.

The program will be offered for 1 year, but may be extended up to 2 years or more depending on your circumstances. Are you able to commit at least 1 year to our program?

Mentorship Interest Form