TOGETHER WE RISE

Full Name *

Email *

Mobile Phone *

Address

Street Address

City

State

Country

Postal Code

What inspired you to apply?

What challenges are you facing right now?

What 1–2 goals do you hope to achieve in 20 weeks?

How will you make space for weekly sessions?

What qualities do you value in a mentor?

When challenges come up, how do you usually see them?

Mostly as setbacks that keep me stuck

Both as obstacles and as opportunities to learn

Mostly as opportunities to grow and change

When someone gives me constructive feedback…

I feel defensive and find it hard to accept

I may resist at first but reflect and try to apply it later

I welcome it and actively look for ways to improve

When I’m under stress, I usually…

Blame myself or others and feel stuck

Pause, take time to process, then decide how to move forward

Stay calm, regulate my emotions, and take intentional action

Would you like to be considered for a donor-supported scholarship?

Yes

No

Review the definition of ALICE (Asset, Limited, Income, Constrained) threshold here: https://www.unitedforalice.org/meet-alice

Do you feel you fall into this definition?

Yes

No

(If yes) Please describe your financial situation and any barriers that make it difficult to cover the full program cost:

Would you be open to optional research participation?

Yes

No

(Your participation helps strengthen our program and allows us to demonstrate impact to donors—making it possible to provide scholarships to women like you.)

Acknowledgment

I understand Together We Rise is not therapy—it is a trauma-informed empowerment program.

I commit to participating in the 20-week journey.

I understand completion of the ROADMAP self-paced course is required before enrollment is finalized.