Hummingbird Project Pre-Registration

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Please note that we will be closed for services from July 15th to December 31st as we are recharging to improve our services for the Hummingbird project. Thank you for your understanding and support. Visit our resource page for national and local resources if you need immediate help. https://www.thehummingbirdprojectct.com/resources .As a partner, community organization or individual you can register an individual that you detect meets the qualifications within the program. Please complete the this pre-registration form completely for services that would best suffice the individual. Please allow 48 hours for a response of an approval or a waitlist notification via email. If approved you will receive an email with a Participant ID # . If we are unable to approve your request we will place your request on a waitlist and will contact you once you’re request can be approved.

((ALL SERVICES ARE FREE))

*Please keep record of the Participant ID #

Thank you for taking the journey of healing with the Hummingbird Project.

Email *

This grant is funded by the Department of Health & Human Services and requires that all participants be eligible for services. (Check all that apply) You must meet A +( B or C) *

(A) I am a Black indigenous person of color (African American, African Caribbean, or Afro Latino or of African descendant)

(B) I am a survivor of sexual assault (molestation, rape, sex trafficking, sexual exploitation, or survivors of child sexual abuse

(C) I am a survivor of sex trafficking or commercial sex exploitation and additional supportive services are needed (housing & food security and emergency services),

I do not qualify ( If you don't qualify we want to thank you for your time by sending you a free Ebook gift via email for your time and support of our work)

Required

How long has it been since you became a survivor? *

Less than 2 year

2-5 years

5 years-10 years

Greater than 10 years

N/A

Required

First Name and Last Initial *

Phone #

Let us know if we need to be anonymous if we contact you via text or phone.

What services were you interested in? Choose as many as you wish. *

Trauma-informed Fitness Boxing Class

Black Women's circles (My Africa Events) Bi-Monthly

Trauma-informed Art Coaching (Use art as apart of healing)

Trauma-informed Medical Evaluations & Exam Services (Safe medical exams)

Trauma-informed Therapy (Therapy that works alongside your Faith)

Survivor Mentorship (The Underground New England) (Sextrafficking overcomer program)

Human Trafficking and Assault Training (Teach your community about safety)

Selfcare Retreats (Retreats are free and for Black women to have self-care moments)

Supportive funds for housing, personal growth or healing modalities (These funds are limited and are reviewed on a case by case basis)

Other:

Required

Has the individual (you) received assistance from the Hummingbird Project? If so, please provide the Participant ID # under the option "other"
*

Yes

Other:

When will you be ready to start your journey? *

YYYY

I am between the ages of *

17 and under ( You will need parental/guardian consent)

18-30

30-50

51 and over

Required

I Identify as being: *

Male

Female

Non-Binary

Required

Would you like to receive emails with information on our services and our other free programming you can participate in? If yes, please provide their email address below. *

Is there anything else you would like us to know? *

How did you hear about us? *

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