This form helps Dream With Purpose understand community interests and plan future programs. Please do not enter Social Security numbers, bank-account information, card numbers, passwords, or other sensitive financial information.
DWP Beauty, Health & Wellness Interest Form
Tell us about your wellness interests and preferred way to participate.
Full name
*
First Name
Last Name
Email address
*
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred contact method
*
Email
Phone call
Text message
Age range
*
12–14
15–17
18–21
22–25
26–30
Please select all that apply. This information helps DWP identify relevant programs, resources, and potential funding opportunities.
*
Current foster youth
Former foster youth
Veteran
None of these
“Are you interested in attending a Beauty, Health & Wellness workshop?”
*
Yes
Maybe—send me more information
No
How would you prefer to attend?
*
Zoom
In person
Either option
Which beauty, health, and wellness topics interest you?
Healthy hair and scalp care
Skin & Nail care
Nutrition & Hydration
Healthy cooking & meal planning
Personal Grooming and Hygiene
Stress Management and Emotional wellness
Beauty Product education and safety
Other
“Would you like information about future nutrition, healthy-food, or wellness resource opportunities?”
Yes
No
Are you interested in learning about careers in the beauty, health, or wellness industries?
Yes
No
Which Career areas interest you?
Cosmetology and Hair care
Barbering
Esthetics and Skin care
Nail Tech
Makeup Artistry
Nutrition and Healthy food services
Fitness and Wellness
Entrepreneurship or owning a business
other
Would you also like information about another Dream With Purpose program?
Financial Capability
Housing Stability
Career & Workforce Development
No, I am only interested in Beauty, Health, & Wellness at this time.
I give Dream With Purpose permission to contact me about programs, workshops, and relevant resources.
*
I agree
Submit
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