2023 MPower Alliance Intake Application
Thank you for your interest in MPower Alliance--we are so glad you found us! Please complete the following form to join our network and learn more about MPower Alliance's services and upcoming events. If you need assistance completing this form, please email Development & Program Director Pearl Chen at pearl@mpoweralliance.org. Any information you share is for internal purposes. 

MPower Alliance strives to be equitable, accessible, inclusive, and safe for all birth mothers/parents. We know that birth mothers/parents come from a variety of backgrounds and we want our in-person and virtual spaces to be welcoming for all. MPower Alliance is not affiliated with any adoption agencies, religious institutions or crisis pregnancy centers.

We understand that some of these questions are sensitive and may be difficult to complete. We appreciate you  taking the time to share your information with us so we can best serve you. 

If you are having thoughts of suicide or self-harm, here are some organizations you can contact:
  • National Suicide Prevention Lifeline at 988. When you call, text, or chat 988, you will be connected to trained counselors who will listen, provide support, and connect you to resources, if necessary. For deaf, hard of hearing use the online chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988. Ayuda en Espanol 1-888-628-9454.
  • Friendship Line call 1-800-971-0016. This is for people over the age of 60 and adults living with disabilities.
  • Trevor Project for LGBTQ+ youth call 1-866-488-7386 or text 678-678.
  • The Mental Health Coalition for immediate support 24/7, reach out to the Crisis Text Line by texting COALITION to 741741
If you are experiencing a medical emergency please contact 911 or go to your nearest emergency room. 
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