GrowMama Mentoring Cohort Application
WAITLIST - IF YOU ARE COMPLETING THIS FORM AS OF MARCH 31, 2022 YOUR NAME WILL BE PLACED ON THE WAITLIST FOR THE NEXT COHORT.

Hello.  Thank you for applying for Brown Mamas' GrowMama Mentoring Cohort 2.  We are currently searching for 10 moms from the Pittsburgh region who are interested in growing with us.  We will focus on the areas of emotional and mental health, resource acquisition, cultural awareness and goal attainment.

Please fill out the form in its entirety below.  You will be contacted no later than March 25th if you are accepted into the cohort.  Thank you.
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Email *
What is your FULL NAME? *
What is your phone number? *
What is your mailing address? *
What part of Pittsburgh do you live in? *
What is your ethnic background? *
What is the highest level of education completed? *
What is your age range *
What is your employment status? *
How many children do you have? *
How old are your children? Check all that apply. *
Required
Are you currently with child (pregnant)? *
How do you feel about motherhood on a scale of 1 "barely hanging on" and 5 "handling with ease"? *
barely hanging on
handling with ease
How do you feel about your mental health on a scale of 1 "barely hanging on" and 5 "handling with ease"? *
barely hanging on
handling with ease
How do you feel about your emotional health on a scale of 1 "barely hanging on" and 5 "handling with ease"? *
barely hanging on
handling with ease
How do you feel about your physical health on a scale of 1 "barely hanging on" and 5 "handling with ease"? *
barely hanging on
handling with ease
Tell us about your parenting relationships.
How do you define your parenting relationship status? *
How would you describe your circle of support as it stands right now? Check all that apply. *
Required
If lacking, where would you like more support? Check all that apply. *
Required
How would you rate your relationship with your child's biological parent on a scale of 1 "we work well together" and 5 "we don't get along at all"? *
we work well together
we don't get along at all
Tell us about your external support systems.
Have you ever participated in a coaching or mentoring program? *
If so, where have you gotten coaching or mentoring?
Have you engaged with ANY service providers and/or community organizations in the last 3 years?  If so, what organizations are you engaged with or have been engaged with? *
Are you a member of any support groups? *
If so, what support groups are you a member of?
Tell us about your goals?
What is your number one goal right now? *
Have you taken any steps toward this goal? *
Define growth. *
When was the last time you had a growth experience?  Tell us about it. *
If accepted into the program, what are you looking forward to working on and accomplishing? *
Thank you for taking the time to fill out our application.  The course beings on April 10th.  If you are accepted, you'll need to have Sundays available to participate. We will be in touch in the next 3 weeks.
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