Mental Health Day Form

Mental Health Day Form
At Women Who Want It All, we believe rest is not a reward — it’s a necessity. This Mental Health Day Redemption is designed to support women who need to take intentional time off to reset, recharge, and care for their well-being.

With this promotion, WWWIA will cover your missed wages for one mental health day — no explanation is required for why you are taking the day off. Your mental health is reason enough.

What You’ll Need to Submit:
Proof of hourly pay (recent pay stub or employer documentation)
Number of work hours you plan to take off for your mental health day

Important Guidelines:
Mental Health Day payments are capped at $300 per day
If your calculated wages exceed $300 for the day, the payout will be limited to the $300 maximum. Payout is based solely on the information and documentation provided

By submitting this form, you acknowledge and agree to the terms above. Our goal is to make this process simple, respectful, and supportive — because choosing yourself should never come with extra stress.

💗 You deserve rest. We’re honored to support you.
Personal Information:
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Mental Health Payout Request:
Was this certificate gifted?
If yes, by whom?
Hourly Pay Rate*
Amount of Hrs. requesting to be paid out*
Total Requested Payout*
Hourly Pay Rate x Hours to be Paid out
How would you like to receive your payout?*

Zelle (Preferred)Venmo
Please provide the necessary details for your selected method (e.g., email for Zelle, Venmo tag etc.):
Required Documentation: REQUIRED
Upload Proof of Hourly Pay*

Cancelof
Photo ID *

Cancelof
Agreement & Submission:
I acknowledge and agree that:*

This Mental Health Day Redemption is intended to cover one (1) mental health day onlyPayouts are based on the hourly pay and number of hours submitted, supported by valid and verifiable documentationMental Health Day payouts are capped at $300 per day, regardless of calculated wages. If my typical earnings for the day exceed $300, I understand the payout will be limited to the $300 maximumSubmission of this form does not guarantee immediate payout and is subject to review and verification by WWWIAAny falsified, altered, or misleading information may result in denial of payout and disqualification from current or future WWWIA promotionsWWWIA reserves the right to request additional documentation to verify eligibilityNo explanation is required for why I am taking a mental health dayBy checking this box, I confirm that all information provided is accurate, truthful, and complete, and I agree to the terms of the WWWIA Mental Health Day Redemption.
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Mental Health Day Form

Personal Information:

Mental Health Payout Request:

Required Documentation: REQUIRED

Agreement & Submission: