ECONOMIC EMPOWERMENT PROGRAM APPLICATION
YWCA Darien/Norwalk's Economic Empowerment Program is a hands-on financial and digital literacy, job readiness and workplace effectiveness program - dedicated to helping women enhance fundamental skills and obtain resources needed to feel economically empowered.
Name
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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.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
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.
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Education Level
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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
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? (Weds 10am-12pm, 2 hours per session, March 26th - May 14th)
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Yes
No
Note any support you need to commit to attending the entire program (i.e. childcare, transportation assistance) and/or known dates that you can't commit (if irrelevant write n/a)
*
What do you hope to gain from participating in this program?
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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
Latine or Hispanic
Native Hawaiian or Pacific Islander
Decline to answer
Other
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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