Request for General Assistance & Services or Appointment with WOT Task Team
This include Connection to WOT, 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
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Your answer
Last Name
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Your answer
Phone Number
Your answer
Email
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Your answer
Zip Code
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Your answer
Age
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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:
I am interested in participating or need assistance for:
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Young Women of Toledo (ages 15 to 26 yrs)
Discovery Coaching - Transitioning
Momentum Program - Entrepreunership Track
Mentorship/ General, Business or Job Shadowing
Women Economic Empowerment Power Hour series
Partnership with my existing group at school or work (also includes collaboration for marketplace, workplace & community)
Access to Technical Assistance/Services/Resources
Connection: I just want to explore my options and learn more about Women of Toledo
Basic Human Needs (Shelter/Food/Personal Safety)
Other:
How can we help/support/assist you?
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Your answer
Time options/ Availability to meet (for one on one appt) *checks all applicable please
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Monday 11:30am to 2:30pm
Monday 3pm to 5pm
Monday after 5:30pm
Tuesday 11:30am to 2:30pm
Thursday 11:30am to 2:30pm
Saturday 9:30am to 12:30pm
Open availability
Other:
Required
How did you hear about the this program?
Your answer
Please share your reasons and interest to participate in any of this program activities or services?
Your answer
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