PLEASEJOINUSONFORTHISFREEEVENT:

Saturday,March7,2015
AssistanceLeagueofSanBernardino
580West6thStreet,SanBernardino,CA92410

Who should aend: Highschoolseniorsandjuniors.

Purpose: TohelpyougetthemostoutofPrombyplanningforyourdress,knowingtheright
e que e,andlearninghowtostaysafeandhealthy.
Topics include: Dress&e que e,health,selfdefense,finances,andcareers.
Acvies include: FindingtheperfectPromdressforyou&yourstyleandge ngamakeover.

Morningsnackandlunchisprovided.Goodiebags,opportunityprizedrawingsincludinga
Promdress!Spaceislimitedtothefirst40girls(seniorsgetpriority).
PleaseemailRachelHartatrachelh@ahuw.org(includePromPromisesRSVPinsubjectline,or

Registration Process
Prom Promises
A program of Arrowhead United Way Womens Leadership Council

INSTRUCTIONS
Deadline: Registration forms are due by March 2, 2015.

STEP 1: DETERMINE IF YOU ARE ELIGIBLE

Eligible participants must be women who:

Are between the ages of 16-24

Have financial needs.
Live, work or go to school in *Arrowhead United Ways service area
Are not a Womens Leadership Council member, an Arrowhead United Way employee or an immediate family
member of either
*Arrowhead United Way service area includes San Bernardino, Big Bear Lakes Area, Bloomington, Colton,
Highland, Lake Arrowhead Area, Loma Linda, and Rialto,

STEP 2: COMPLETE THE APPLICATION

Registration is complete once you have:

Filled out the attached registration form

Completed the Parental Permission/Communication Release with appropriate signatures

STEP 3: SUBMIT YOUR REGISTRATION FORM IN ANY OF THE FOLLOWING WAYS:

Send completed registration form via:

Mail:
Scan&Email:
ArrowheadUnitedWay
Rachelh@ahuw.org
Subject:
Interview for Success
A n:RachelHart
646NDStreet
SanBernardino,CA92401
RE: Interview for Success

Fax:
A n:RachelHart
909.885.4096
RE: Interview for Success

ALL APPLICANTS WILL BE ACCEPTED. WORKSHOP WILL BE HELD, RAIN OR SHINE!

ALL FUTURE COMMUNICATION WILL BE THROUGH EMAIL OR PHONE.

PLEASE BE SURE TO USE AN EMAIL YOU CHECK REGULARLY FOR
THE MOST UP TO DATE INFORMATION REGARDING THE EVENT.

This was made possible by:

Application/Registration Form
A program of Arrowhead United Way Womens Leadership Council.

Pleaseselecttheprogram(s)youwouldliketoregisterfor:

CollegeCruise

HealthyLifestyles

InterviewforSuccess

Dateofprogramyouareapplyingfor:

TodaysDate:
Howdidyoulearnaboutthisprogram?

Whyareyouinterestedinpar cipa ng?

ContactInforma on:
FirstName:
Address:

LastName:

City:

HomePhone: ()

State:

ZipCode:

CellPhone: ()

EmailAddress:

Age:

Bestwaytocontactyou?

Educa onInforma on:

IhaveaDiploma?
Currentlya ending:

No GED HighSchoolDiploma
HighSchool

College

CurrentlyA endingSchool?

Technical/Voca onal

Yes

No

Other
Expectedcomple ondate:

NameofSchool
Brieflydescribeyoureduca onalgoals:

EmploymentInforma on:
Iamcurrentlyworkingfull me:

Iamcurrentlyworkingpart me:

Iamunemployedandlookingforpart mework

Iamunemployedandlookingforfull mework
Iamnotlookingforwork

Brieflydescribeyourcareer/workinggoals:

Sendcompletedapplica on/registra onformtoRachelvia:

Mail:
Scan/&Email:
Fax:
A n:RachelHart
ArrowheadUnitedWay
Rachelh@ahuw.org
Subject: Interview for Success 909.885.4096
A n:RachelHart
RE: Interview for Success
646NDStreet
SanBernardino,CA92401
RE: Interview for Success

Arrowhead United Way

646 North D Street
Post Office Box 796
San Bernardino, California 92402-0796
tel (909) 884-9441
fax (909 885-4096
www.ArrowheadUnitedWay.org

Communications Release & Parental Permission Form

Site Information
Event Interview for Success
Location SBETA

Date March 2015

Publicity Authorization and Release

Student Name

Date

Day Phone

E-Mail

Address

City, State, ZIP

I hereby assign the rights to interview transcripts, video recordings and/or photographic recordings made of me by Arrowhead
United Way Womens Leadership Council hereafter referred to as AUWs WLC, to said United Way.
I hereby authorize the editing, duplication, reproduction, copyright, exhibition, broadcast and/or nonprofit use and
distribution of said transcripts, recordings and/or photographs for purposes deemed suitable by AUW. Such promotion
includes, but is not limited to, publication of said transcripts, recordings and/or photographs in newspapers, newsletters and
other mass media.

Parental or Legal Guardian Consent and Release

If the individual is a minor (younger than 18 years old), the following must be signed by a parent or legal guardian:
I hereby consent and agree, individually and as a parent or legal guardian of the minor, to all the terms and provisions above.

Parent/Guardian Signature

Date

Parent/Guardian Name

Day Phone

Relationship to minor

E-Mail