Submit completed applications no later than October 09, 2020

I commit myself to the following dates: (These dates are in ADDITION to meeting monthly and weekly check-ins with your mentor) (DATES MAY BE SUBJECT TO CHANGE. ALL DATES WILL BE CONFIRMED BEFORE ACCEPTANCE OF THIS APPLICATION.)

**WoW Utah Empowerment/Purpose & Life Skills Intention & Implementation – Two-day Retreat, January 8-9, 2021**

    Day 1, Jan 8, 2021

  • Take "Before Photos"-All Women of Worth participants receives sweatshirt to wear. However, please dress comfortably.
  • Welcoming
  • Life skills training
  • Goals and commitments
  • Lunch/Dinner
  • Meet and greet with mentor
  • Guest Speaker - Evening session
    Day 2, Jan 9, 2021

  • Ah Ha moments
  • Journaling and moving forward
  • Reflection time - Gratitude
  • Panel of courageous women of worth
  • Lunch
  • Mentors and mentee time

Additional Dates of Commitments (Worthshop’s content subject to change)

    Date

  • February 13
  • March 13
  • April 9-10
  • May 8
  • June 12
  • July 10
  • August 14
  • September 11
  • October 9
  • November 12-13
    Activity

  • Vision Books
  • Mindfulness
  • The Wow Factor
  • Chad Hymas
  • Soul Signature
  • Drum Circle
  • Refuse to Be A Victim
  • Shopping Spree
  • Festival for all WoW Family past and present and Families
  • Gala & Silent Auction Event

***** Must be able to stay overnight on required two-day WorthShops. Arrangements must be made for childcare & pet care.

10th Annual Gala & Silent Auction Weekend – Three-day Event, November 12-13, 2021

**Hotel Accommodations & Food for will be provided

    Nov 12, 2021 Day one:

  • Full day of reflection, guest speakers and where we areand where we are going.
  • Manicures/Pedicures in the evening
    Nov 13, 2021 Day two:

  • Makeover - Haircuts and Makeup Makeovers
  • Dress for Gala Event
  • Catered dinner
  • After photos
  • Entertainment
  • Awards Ceremony and Recognition
  • Over Night Hotel Stay for two nights – Friday to Sunday

I am being Nominated by or I would like to apply for myself.

I know personally, socially, or through employment or am related to someone in WoW Utah. (if yes, please explain):

To be successful in WoW Utah, we need to understand your current and past challenges that led you to apply for this program. Please explain:

Please explain how and why you are committed to moving forward in your life. Please use your own words.

How long have you been clean and sober? (N/A if not applicable)

Are you, or have you been, in a domestic violence or polygamy situation? If yes, please explain in your own words. If not applicable (N/A).

Do you smoke? YesNo

Is English your first language? YesNo (for Mentoring match-up and Materials)
If no, please explain:

Are there any medical conditions, food or other allergies that we need to be made aware of?

I am on medication for a medical condition YesNo
If yes, please explain:

If you are under a therapist’s or physicians care would he/she give letter of clearance to participate in this program?
YesNo

Would you allow us to contact the therapist or physician for support in your journey? YesNo

If no, please explain:

Name of Therapist or Physician:

I am pregnant: YesNo
If applicable, I am due:

Please communicate if there is a concern to participate in the overnight WorthShops or activities:

Each applicant or nominee will be required to interview in person prior to acceptance into the program.

I understand I will not be accepted into the program until I have had an interview in person.

I (Women Of Worth nominee/applicant’s signature) wish to participate in the WOW Utah, Inc.–Women of Worth and hereby give the WoW Utah staff or any affiliates permission to discuss anything in my nomination form.

I hereby:

(A) waive, release, and discharge from any and all liability for the death, disability, personal injury, property damage, property theft or actions of any kind including and not limited to emotional or psychological effects which may hereafter accrue to me or my organization/business named above (if applicable), WoW Utah and its representatives, officers, agents, and employees

(B) indemnify and hold harmless WoW Utah and its representatives' officers, agents, and employees from any and all liabilities and claims made by other individuals or entities as a result of any of my actions or the actions of any representative, participant, or an agent, employee, or member of my organization/business* named above (if applicable)

I hereby agree while being involved in this program, I will abstain from any drugs’ alcohol or any other mind-altering substances.

I, the undersigned, on behalf of myself and my of organization/business named above (if applicable).

(A) Acknowledge that I have read and understand the waiver and release described herein;

(B) Affirm that this release and waiver shall be construed broadly to provide release

(C) Waiver to the maximum extent permissible under applicable law

(D) I am aware the only person(s) to be in my hotel room at any time is my WOW roommate, other women of worth, or WOW Utah staff. I also understand that I may not leave the premises of the hotel until the program of the 2(two) days have concluded unless given permission.

(E) I commit to a once a month WorthShop, meetings in person with my mentor, monthly check-ins by email and by phone with my mentor. Not adhering to these commitments could warrant removal from the program.

(F) I fully commit to be in touch with and respect the time(s) set up with myself and my mentor. Should I have
to cancel I will call or text to reschedule another time and date. I will commit to connecting and staying in contact with my mentor per the guidelines of this program. I will attend all the dates of commitment for the WorthShops and meeting with my mentor.

Not adhering to any of these stipulations or not committing to the agreed WorthShops or mentee meetings in this agreement may warrant immediate removal from the WoW Utah program.

Date:

Signed:

Women of Worth’s Information Sheet

This is for informational purposes only, for you to have choices on the attire that you receive. (Attire, jewelry, and accessories may be new or gently used.) (Gowns and formal shoes, jewelry, and handbags will be loaned for the formal event and will be collected after the Gala Event and returned to WoW Utah’s Wardrobe.)

Name of Women of Worth:

Phone Number:

Alternate Phone Number:

Hip Measurement:

Waist Measurement:

Bust Measurement:

Dress Size:

Skirt Size:

Pant Size:

Top Size:

Daily Shoe Size:

Dress Shoe Size:

Height:

Weight:

Hair Color:

Age:

Preferred Faith: *** WoW Utah, Inc is a non-denominational nonprofit Program ***

Emergency Contact

Name:

Phone #:

Relationship:

I wish to participate in the WOW Utah, Inc.–Women of Worth and hereby give the WoW Utah staff or any affiliates permission to discuss anything in my nomination form.

Signature:

Date: