Trailblazer Program                                              Interest Form 

  Thank you for your interest in enrolling your daughter in the Young Women on the Move (YWOM) Trailblazer program this fall! Please complete this form to help us better serve you. We look forward to meeting you!  

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Parent/Guardian Name
Parent Phone Number 
Parent Email Address 
Student Name 
Required: Fall information session 
Attendance at one of these sessions is required before your daughter can be enrolled in YWOM.   

During the information session, you’ll learn about YWOM’s mission, goals for the upcoming year, and the steps required for successful enrollment. You'll also have the opportunity to ask questions and complete any necessary paperwork.  
Please select one of the following options to attend an information session
Questions or concerns? 

Asia Upton
Program Coordinator
asiaupton12@gmail.com
913-617-1160

The Young Women on the Move building is located at:
3148 Parallel Parkway, Kansas City, KS 66104

www.youngwomenonthemove.org
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