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Home
About
Mission
Leadership
- Founder & CEO
- Board of Directors
Partners
Programs
Media
Events
- WOD Events
- Past Events
Contact

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Empowering A New Generation of Young Girls and Women

Group Facilitator Screening

This form is for those wanting to become a Group Facilitator with Women of the Dream.

"*" indicates required fields

Δ

Name*

First Middle Last

Date of Birth*

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email Address*

Are you currently in school?*

Yes

No

What school are you enrolled in?*

Are you currently employed?*

Yes

No

Do you work part-time or full-time?*

Part-time

Full-time

Do you have a car?*

Yes

No

Do you have experience working with teen girls in urban areas such as a mentor, teacher, or in any other capacity? Describe below**

Are you available to provide group services with our girls on weekdays between the hours of 9AM and 3PM?*

Yes

No

What days of the week and times of the day are you available to provide group services?*

Are you available to chaperone trips and other social activities on weekends?*

Yes

No

Is there other information you wish to share?

Background Check

This information will be kept confidential and secure.

Will you agree to have the Women of the Dream check your background through federal and state agencies for criminal records and child abuse and neglect proceedings?*

Yes

No

Previous Last Names*

Write none if there are none.

Last

Social Security Number (Required for criminal records check)*

Do you have a valid Driver’s License?*

Yes

No

Driver License Number*

State Issued*

Date Issued*

Expiration Date*

Have you ever been arrested and/or convicted of a crime?*

Yes

No

Please explain in detail. Include dates and disposition.*

Would you like a copy of your background check?*

Yes

No

Contact Us

Call Leslie
Email Leslie
Camden, New Jersey

Partner Schools

Charles Brimm Medical Arts High School
Camden Big Picture Learning Academy
Camden High School
Creative Arts High School
Veterans Memorial Family School

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