FAME House Application

(Female Alliance of Mothers and Entrepreneurs)
My Baby My Way Foundation

Instructions:
Thank you for your interest in the FAME House program. Please fill out this application form completely. All information provided will be kept confidential. Once your application is reviewed, you will be contacted to schedule an interview.

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Name

Date of Birth

Phone

Address (Current or Last Known)

LinkedIn, Facebook, or Instagram page. Type NA if none.

How did you hear about us?

Other Details: What would you like to add?

Current status:

Text are you currently pregnant? Yes, no, or I’m sure and I would like to take a free test.

If yes, how many weeks? Enter NA if no.

Do you have children? (required)

Yes

If yes, how many and what are the ages? Enter NA if no.

If Yes, are they eligible for childcare assistance or on a childcare subsidy program like CalWorks or RCOE?(required)

Yes

Other

If not, why are they not eligible? Enter NA if yes.

Do you receive financial assistance, such as TANF or cash aid?(required)

Yes

Not eligible

Other:

Current housing status: Housed, Homeless, or Transitioning?

Other or housing facility info:

Program Eligibility

Are you between the ages of 16 and 24?

Are you currently single? If not, what is your status?

Are you willing to participate in training and educational programs, including in college enrollment, job, and life skills development?

Will you require on-site childcare to participate in the program?

Employment and Education:

What is your highest level of education and are you currently employed?

Program Goals and Interests:

Why are you interested in participating in the FAME House program?

What are your personal goals for yourself and or your children?

Availability:

If selected for an interview to participate, when will you be available to begin the program?

Emergency Contact:

Full name and relationship

Phone number

Sex: Male, female, transgender. Preference: Straight, BI, LBGTQ. Please type your response.

What skills or training are you most interested in developing with us?

E-Signature and Agreement:

By submitting below, I confirm that the information provided in this application is true and accurate to the best of my knowledge, and this will be considered my consent and signature. I understand that participation in the FAME House program requires a commitment to the training, education, and support services provided. I also understand that this is a women-only facility, and I must meet all eligibility requirements to be considered. SUBMIT BELOW

Thank you for your interest in the FAME House program! We look forward to reviewing your application and discussing how we can support you on your journey to self-sufficiency and success with us.