This Christmas, Women to Woman is blessing high school girls in Georgia and in Ohio, with a $100 holiday gift card and a message of encouragement. The goal is to support girls who are showing strength, character, and goals for the future but may be facing financial or emotional hardship this season.

Personal Information

Full Name

Date of birth

Age

State

Grade:

School Name

Home Address (for mailing the gift card):

Phone Number (or Parent/Guardian’s Phone): *

About You

Tell us a little about yourself.

Why would receiving this $100 gift card make a difference for you this Christmas?

What are your goals for the future?

How would you describe the kind of person you are becoming?

Parent or Guardian Consent:

Parent/Guardian Consent

I give permission for my teen to participate in the Women to Woman Adopt a Teen for Christmas program. I understand this information is confidential and used only to coordinate mailing of the gift card.

If you are under 18, your parent or guardian must approve your participation.

Parent/Guardian Name:

Phone or Email:

Parent/Guardian Signature:

Date

Applicant Signature

I certify that the information provided is true and complete. I understand that completing this form does not guarantee selection, as recipients will be chosen based on need and program guidelines.

Applicant Signature

Clear

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