PartnerUp Mentoring Program Application - West Virginia Women Work

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Who We Are
What We Offer
How You Can Help
Resources
Contact Us
- Accessible Contact Options
- West Virginia Women Work Media Kit

Name *

First

Last

What is your preferred name/nickname?

If you go by a name other than your given name please tell us here

Please share your pronouns

She/Her/Hers
He/Him/His
They/Them/Theirs
Other Not Listed (please list below)

Pronouns other

Are you currently a student or alumni of Step Up for Women Construction or Advanced Manufacturing? *

Yes
No
Applied previously but have not attended the program yet

Where did you learn about the PartnerUp program? *

Flyer
Trifold/Brochure
Social Media
Step Up Student/Alumni
Referred by Someone (please let us know who)
In-person Event (please list which event)
West Virginia Women Work Website

We want to make sure we are reaching everyone and using our marketing efforts to our best ability. Please let us know how you heard about the program.

Who referred you to PartnerUp? *

Which in-person event did you learn about PartnerUp? *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth *

Current Household Income? *

0 - 10000
10000 - 25000
25000 - 50000
50000 +

How do you prefer communication between you and your mentor? *

Email
Text
Phone Call
In Person
Zoom

What is your highest level of education? *

High School Diploma
Some College
College Degree
Other

Highest level of education other *

What barriers do you need help addressing? *

Lack of or Not Enough Food
Childcare
Homelessness
Addiction(drug or alcohol)
Domestic Abuse
Transportation
No Current Barriers
Other (Please Explain Below)

List any other barriers you are currently facing. *

What are your current goals? *

Overcome Current Barriers
Budgeting/Credit Help
Get HSE (formally GED)/High School Diploma
Attend College/Vocational School
Career Exploration
Job Readiness Skills
Resume Writing/Review
Other (Please Describe below)

Other Goals Not Listed Above *

Is there anything else you would like us to know about you?

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First

Last

Email *

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