Multi Assistance
Resource Centers Inc.

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- About MARC
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Mother Matter
Seeking Safety
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- Referral Form
- Mother Matter Initiative – Interest Form
Donate

Home
About
- About MARC
- Our Services
Mother Matter
Seeking Safety
Contact Us
Forms
- Referral Form
- Mother Matter Initiative – Interest Form
Donate

Interest Form

Thank you for your interest in the Mothers Matter Initiative, a program designed to empower and support mothers in our community. Please fill out the form below to express your interest in participating.

Personal Information:

Full Name

Date of Birth

Address

Phone Number

Email Address

Demographic Information (Optional)

Demographic Information (Optional):

Race/Ethnicity

Preferred Language

Gender

Are you a mother?

Demographic Information (Optional)

Program Interest:

What interests you most about the Mothers Matter Initiative? (Please select all that apply):

Emotional Support & Counseling Parenting Resources & Education Legal Advocacy & Support Community Engagement & Leadership Opportunities Economic Empowerment (Job Training, Financial Literacy) Access to Health & Wellness Resources Other

Please specify

What specific challenges are you currently facing as a mother? (Please briefly describe):

How do you believe the Mothers Matter Initiative could support you? (Optional):
Availability and Commitment:

How often would you be able to participate in program activities?

Weekly Bi-weekly Monthly As needed Other

Please specify

Do you have any specific needs or accommodations to participate in the program?

Yes No

Please Describe

Additional Information:

How did you hear about the Mothers Matter Initiative?

Flyer/Poster Social Media Word of Mouth Community Event Referral from an organization Other

Please specify

Would you like to receive updates about the program and other resources?

Yes No

Signature:
By submitting this form, I am expressing interest in the Mothers Matter Initiative and give permission for the information provided to be used to assess my eligibility and program involvement.

Signature:

Date:

Multi Assistance
Resource Centers Inc.

Home
About Us
Our Services
Contact Us
Client Intake Form
Referral Form
Donate
Our Accomplishments
Mother Matter
Seeking Safety

Home
About Us
Our Services
Contact Us
Client Intake Form
Referral Form
Donate
Our Accomplishments
Mother Matter
Seeking Safety

Just a small donation could make a huge difference to someone's life

Donate Now

Multi Assistance Resource Centers Inc. 2025

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Multi AssistanceResource Centers Inc.

Interest Form

Multi AssistanceResource Centers Inc.

Just a small donation could make a huge difference to someone's life

Multi Assistance
Resource Centers Inc.

Multi Assistance
Resource Centers Inc.