GEG Application - English Application
Please use the form below to fill out your information and complete the application for the WEI Girl's Empowerment Group Program.

If you have any questions, please feel free to contact Jannatul at Jannatul@wei-ny.org.


Personal Information
First Name *
Last Name *
Email *
Your Birthday (Format mm/dd/yyyy) *
Home Phone *
Mobile Phone *
How old are you? *
Street Address *
City *
State / Province *
Zip / Postal Code *
Country *
What school do you attend? *
What grade are you in? *
What is your ethnicity? *
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