top of page

Home
About
Shop
Events
Cybersecurity Program
Workshops
SMN Relief
Meet the Founder
Get Involved
Contact
More

Use tab to navigate through the menu items.

Single Mom Registration

Please fill in the form below.

First name*

Last name

Multi-line address

Country/Region*

Address*

Address - line 2*

City*

Zip / Postal code*

Phone*

Email*

Are you A Single Mom?

Yes

Which of the following best describe your situation.

Widow

Never Married

None of the Above

How long have you been a single mom?

What are some of the main challenges you have faced as a single mom? Please be specific and add as much information as possible.

Do you currently have a support group or people that you can call on for help when needed? If Yes who?

How many children do you have?

Please select which one applies to you?

College Degree

Some College

High School Diploma

GED

None of the Above

Are you currently employed?

Yes

If you had the opportunity to receive an education, further your current education, or learn a trade would you take advantage?

Yes

Maybe

Have you ever thought about owning your own business?

Yes

Which workshop would interest you the most? Please only choose one.

Finance-Budgeting, Generating Wealth, Etc.

Career Building

Entrepreneurship

Health & Wellness

Lifestyle-Cooking, Parenting, New Moms Do's & Don'ts, Dating

Homeownership

Please select all of the following workshops you would be interested in attending

Finances

Career Building

Entrepreneurship

Health & Wellness

Lifestyle

Homeownership

Are there any other concerns you have as a single mom that you think would make a great program initiative or workshop?

Would you be interested in attending social events in your area catered to single moms?

Yes

Maybe

CONFIDENTIALITY NOTICE: The contents of this survey and any attachments are intended solely for the addressee(s) and may contain confidential and/or privileged information and may be legally protected from disclosure.

bottom of page