Thank you for being here

Welcome to our application page. We are here for you, ready to support you beyond life’s dark moments so you can experience joy, embrace healing and find your wings. Please help us get to know you better by filling out the application below. A member of our team will be in touch with you soon to follow up. We look forward to meeting you!

-The Monarch’s Way Team

Name

First Name

Last Name

Current Address (City, State)

Nickname (If any)

Are you a US Citizen? (If not, what is your country of citizenship?)

Age

Date of Birth (Month, day, year)

Phone number or email address

Is it ok to leave a voice mail?

What is the best way to get in contact with you to set up an interview?

Please tell us who you are currently living with and what their relationship is to you (Ex: I live with my Aunt who is my mother's sister.)

Do they know you are filling out this form?

What grade are you in?

What is the last school you attended?

How did you learn about Monarch's Way?

Why do you want to come to Monarch's Way? (Please describe in a few sentences so we can get to know your needs.)

In your opinion, what would make your life better?

Do you have any fears in coming to Monarch's Way? If so, please let us know.

Is there any information that you think Monarch's Way needs to know?

Is there anyone in your life who makes you feel supported? If yes, who? What does he/she do to make you feel supported?

Have you ever been to any other programs? If so, list them here.

Have you seen a counselor in the past or are you currently seeing a counselor? Has it been helpful?

Are you pregnant? (The Monarch's Way program accepts pregnant teens.)

We work with girls from many different backgrounds, including sexual assault suriviors, those who have attempted suicide, unplanned pregnancies, those who have suffered mental or physical abuse, runaways, mild eating disorders, anxiety and depression, etc. Is there anything that you would like to share with us initially about your story that will help us to serve you better?

PLEASE READ
By submitting this form, I acknowledge that the information provided herein is accurate and true to the best of my knowledge. I also understand that any false information may cause and result in disqualification from admittance into the program.

We are dedicated to helping struggling teen girls. Your ability to share honestly allows the staff at Monarch's Way to best evaluate your current situation and determine if we can offer the support you need. We have so much hope for you and looking forward to getting to know you more.