Program Participant Info

Welcome to Dress for Success Quad Cities! Please fill in the form below to the best of your ability. This information helps us apply for grant funding and design our programs to best meet the needs of our community.

Your data remains private.












    (Please select all that apply.)
    NoneCash assistanceChildcare assistanceFood stampsHousingMedicaidSSI or RSIDUnemployment

    Less than 9th gradeSome High SchoolHigh School DiplomaGED / HiSETTechnical or Vocational DegreeSome College2-year Associate's degree4-year Bachelor's degreeSome Graduate SchoolGraduate, doctoral or terminal degree

    AsianBlack/African AmericanHispanic/LatinaMulti-RacialNative AmericanWhite/CaucasianOtherPrefer not to say





    SingleMarriedDivorcedSeparatedWidowed

    YesNo


    NoI'm an immediate family member of a US veteranI'm the spouse of an active duty military memberYes, I'm dischargedYes, I'm activeYes, I'm retiredYes, I'm a reservist

    US Born CitizenUS Naturalized CitizenImmigrantRefugee


    YesNo


    I'm unemployed and currently job searchingI have an upcoming job interviewI'm employed full-time but am thinking about going back on the job marketI'm employed part-time and looking for a full-time jobI'm employed but want to invest in my professional developmentI'm employed and want to connect and network with othersOther


    (If this does not apply, please skip this.)


    (If this does not apply, please skip this.)


    (If this does not apply, please skip this.)


    YesNo


    YesNo


    YesNo


    Google searchSocial media (Facebook, Instagram, LinkedIn, etc.)Referred by another agencyA friend or family memberA fundraising event or saleA volunteer organizationOther


    (If you were not referred by another organization, please select None.)





    (Please select all that apply.)
    Networking Opportunities (opportunities to connect and network with other QC women)Financial Literacy ProgrammingJob FairsCareer & Professional Development WorkshopsGuest Speakers & WorkshopsPersonal Development Workshops (e.g., health/wellness, mindset, leadership, resources, etc.)Social Opportunities (opportunities to socialize with other QC women)Access to Free and Low-Cost Professional Clothing & Attire

    *I understand that I must come alone to any scheduled appointments at Dress for Success Quad Cities, including the Interview Outfit appointment or career coaching sessions.
    *I understand that if I do not call to cancel or show up for a scheduled appointment with Dress for Success Quad Cities, then I will not be able to use the StyleHER or Career Coaching services for 1 year. Please note: as long as you notify us prior to your scheduled appointment, we can reschedule your appointment up to 2 times.
    *I understand that by utilizing the programs and services of Dress for Success Quad Cities that I agree to allow my likeness and statements to be captured and used for marketing purposes.

    I would like to receive email notifications about upcoming workshops and events.