Financial Literacy Program Enrollment

Name:

Email:

Phone:

Do you identify as a woman?

What race or ethnicity do you identify as?

Are you pregnant or parenting?

If pregnant, when are you due?

How many children do you have? What are their ages?

Do you identify as a single mother?

Age Range

Best Time to Call

Address

Current Job/Educational Status

What career or goal are you pursuing?

Entrepreneurship

Self Development & Healing

Trade School

Higher Education

Parenting & Single Motherhood

Career Readiness

Tell us more about your career or personal goals. (Please be detailed)

With your current schedule, when would you be available for mentoring?

What are you hoping to achieve as a result of mentorship?

Are you in high school?

What school or university do you attend? (if applicable)

What traits are you looking for in a mentor?

Tell us about you: What do you like to do for fun? What hobbies, passions, or talents do you have?

What resources do you need? (housing, food, daycare, etc.)