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👑 Women’s Empowerment Circle Intake Form

Birthday
Month
Day
Year
Multi-line address
Are you employed?
Yes
No
What areas are you seeking strength or support in? (Check all that apply)
Do you currently have a support system (friends, family, community)?
Yes
No
Have you participated in any women's circles, support groups, or empowerment programs before?
Yes
No
Are you comfortable sharing in group settings?
Do you have children?
Yes
No
Do you need childcare or transportation assistance to attend meetings?
Yes
No
Are you willing to participate in weekly or bi-weekly empowerment sessions?
Yes
No
Would you be open to being paired with a sister-partner for accountability and check-ins?
Yes
No
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