One Purse Dream Fund Application
Requirements for Application:
A female survivor who has completed at least 9 months in a partner restoration care home, affiliate, or program.
A written letter of recommendation submitted by a counselor, mentor, or program director who has spent a minimum of 6 months working directly with the applicant.
Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Email Address (if available)
Your answer
Contact Phone Number (if available)
Your answer
Restoration Care Home or Program Name *
Your answer
How many consecutive months have you participated in this program? *
Your answer
YOUR STORY *
Tell us about yourself. (This is Confidential)
Your answer
YOUR DREAM *
If you have a dream for your life, please share it with us here. I have a dream to (be, learn, do, accomplish.......) If you don't have a dream for your life yet, that is fine. Our program will help you to discover your God given talents, and uncover the dreams buried deep in your heart.
Your answer
What are your plans for the future?
Your answer
What do you think is your greatest talent or strength?
Your answer
What is your greatest struggle in moving forward?
Your answer
What do you enjoy doing in your free time?
Your answer
Tell us about your relationship with God (not required).
Your answer
Referral Name *
This is the name of the mentor, counselor, program director, or other individual who is standing in agreement that you are ready to take hold of a new vision for your future.
Your answer
Referral Email Address *
Your answer
Referral Phone Number *
Your answer
Additional Comments:
If you have any additional information that you would like for us to know, please feel free to share below.
Your answer
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