"Smart Girl Secrets" Interest Form

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Smart Girls Only offers a range of empowering programs designed to foster personal growth and mental health awareness. "Smart Girl Secrets" focuses on nurturing well-rounded individuals, promoting inclusivity and leadership. This program is open to young women aged 12 to 21 years, and is offered in small cohorts spanning 12 months each.

If you are interested in participating, please complete this form in its entirety. Upon review of your submission, a member of the Smart Girls Only team will reach out to you regarding next steps.

What is your first and last name? *

When is your birthday? *

YYYY

What is your email address? *

What is your phone number? *

How did you learn about this program? *

Smart Girls Only website

Friend

Family Member

Social Media

Other:

Please describe one to two personal goals you have that can be achieved within 12 months. *

Please describe one to two professional goals you have that can be achieved within 12 months.

What outcomes are you looking to gain from participation in this program? *

This program requires the ability to practice inclusivity in thought and remain open to vulnerable dialogue. This program has a strict confidentiality requirement for any personal information discussed within the cohort for all participants before, during, and after program involvement. Do you agree to these terms? *

Yes

This program requires engagement with a mentor for the full duration of the program. Additionally, monthly virtual group workshops are required. Are you able to make this commitment? *

Yes

*UNDER 18 PARTICIPANTS ONLY*

This program requires strict confidentiality for personal identifying information such as first/last names, school names, birthdays, or any related applicable personal information that may arise in an open forum. We allow one parent or guardian to participate in this program as a secondary participant. We request that any parent or guardian who attends the program be held to all of the rules and standards of conduct as the primary participant. Do you agree to these terms?

Yes

I am over the age of 18 and do not need a parent or guardian as a secondary participant

I am under the age of 18 but I have permission from my parent or guardian to participate in this program on my own. I agree to provide their contact information with my submission.

*UNDER 18 PARTICIPANTS ONLY*

If you are the parent or guardian, or have opted to provide your parent or guardian contact information, please include:

First and Last Name

Phone Number

Email

Thank you for taking the time to submit this form! A member of the Smart Girls Only team will review your submission and follow up with you via email within 48 to 72 hours. Do you have any additional questions about the program? *

Submit

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