Request for Assistance & Services with WOT
This include Technical service or Assistance for resources.
*Note we ask for demographic for our GRANT reporting, not as a determining factor for participating. No personal information will be listed in grant reporting or publicly. All information provided is only for internal purpose and confidential. Thank you!
* Required
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
Your answer
Email
*
Your answer
Zip Code
*
Your answer
Age
*
18 - younger (Gen Z)
19 - 37 (Millennial/Gen Y)
38 - 63 (Gen X)
64 - 74 (Gen J)
75- 92 (Baby Boomers)
93 + ( Silent/GI)
Other:
I Identify my ethnicity as: (select all that apply)
Black or African American
Hispanic/Latinx
Native American or American Indian
Asian / Pacific Islander
Biracial
Prefer Not to answer
Other:
How did you hear about the this program?
Your answer
I am interested in participating for:
*
Young Women of Toledo (ages 15 to 26 yrs)
Discovery Coaching
Momentum Program - Entrepreunership Track
Mentorship/ Business or Job Shadowing
Women Economic Empowerment Power Hour series
Partnership with my existing group at school or work
Technical Assistance/Services/Resources
Other:
Please share your reasons and interest to participate in any of this program activities or services?
Your answer
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