Pre-registration

Hummingbird Project Pre-Registration

As a partner, community organization or individual you can register an individual that you detect meets the qualifications within the program. Please complete the this pre-registration form completely for services that would best suffice the individual. Please allow 48 hours for a response of an approval or a waitlist notification via email. If approved you will receive an email with a Participant ID # . If we are unable to approve your request we will place your request on a waitlist and will contact you once your request can be approved.

First name

Phone

Check all that apply:

(A) I am a Black indigenous person of color (African American, African Caribbean, or Afro Latino or of African descendant)

(B) I am a survivor of sexual assault (molestation, rape, sex trafficking, sexual exploitation, or survivors of child sexual abuse

Optio(C) I am a survivor of sex trafficking or commercial sex exploitation and additional supportive services are needed (housing & food security and emergency services),n 3

I do not qualify but want to connect

Has the individual (you) received assistance from the Hummingbird Project?

Yes

Other

What services were you interested in? Choose as many as you wish.

Black Women's circles (My Africa Events) Monthly

Trauma-informed Therapy (Therapy that works alongside your Faith)

Human Trafficking and Assault Training (Teach your community about safety)

Supportive funds for housing, personal growth or healing modalities (These funds are limited and are reviewed on a case by case basis)

When will you be ready to start your journey?

Month

Day

Year

I am between the ages of :

17 and under

18-30

30-50

51 and over

I Identify as being:

Male

Female

Non-Binary

Would you like to receive emails with information on our services and our other free programming you can participate in? If yes, please provide their email address below.

Is there anything else you would like us to know?

How did you hear about us?