Winter 2020 Intake Form

Name

First Name

Last Name

Email Address

Phone Number

(###)

###

####

How did you hear about Women's ALTER?

Groups/ Companies / Communities you contribute to

Why do you believe that this is the right time for you to participate in Women's ALTER?

What would you like to focus on during Women's ALTER?

What would you like support with?

What do you hope to get out of this course?

What are your personal and professional goals that you'd like to actualize?

Do you have any needs that you'd like us to know about?

(i.e. learning styles, invisible disabilities, etc)