Young Black Women's Project Registration Form (Fall 2025) Survey

The Young Black Women's Project is a leadership program for African, Caribbean, and Black femme-identifying and gender-diverse individuals in the Peel Region! Over the course of 8 weeks you will get the chance to build capacity in advocacy skills, wellness strategies, career-building skills, as well as learning more about sexual health and destigmatizing sexual wellness. Participants who complete the 8 weeks will receive a certificate AND a wellness package packed with lots of cool goodies to help you become the most successful Black womxn you can be!

1.Please provide your first and last name.(Required.)

2.Please indicate your age.(Required.)

3.Please provide your email address.(Required.)

4.Please provide your address.(Required.)

5.Please provide your cellphone number.(Required.)

6.Do you identify as African, Caribbean, and/or Black?(Required.)

Yes

8.Are you an Indigenous individual?(Required.)

Yes, First Nations.

Yes, Inuit.

Yes, Métis.

No, I am not.

9.*Place holder: Are you available for the following dates from 6:00pm-8:00pm:
Thursday October 16, 2025
Thursday October 23, 2025
Thursday October 30, 2025
Thursday November 6, 2025
Thursday November 13, 2025
Thursday November 20, 2025
Thursday November 27, 2025
Thursday December 4, 2025(Required.)

Yes, I can attend all of these sessions.

I can attend some but not all.

No, I cannot attend any of these sessions.

10.Why would you like to participate in the Young Black Women's Project?(Required.)

11.Are you willing to participate in group conversations and activities around self-care, sexual wellness, and leadership skills?(Required.)

Yes

12.This series will be hybrid and will feature both in-person and online sessions. There will be an In-person graduation ceremony session that will take place at 7700 Hurontario Street Unit 601 Brampton, ON. Are you able to access both in-person and online sessions?

Yes

I can access virtual but not in person sessions.

I can access in-person sessions but not virtual sessions.

13.Do you have any accessibility needs we should be aware of? If so, please outline what these needs are. (i.e subtitles on ZOOM, transportation needs to in-person sessions, etc.)(Required.)