Worksheet

2022/23 MotherWorthy Equity Seat Request Form

Because of the historical and present day systemic inequities that disadvantage people of Black, Indigenous, Latinx, Asian and mixed-race heritage, I am offering “Equity Seats” for BIPOC mothers who are interested in joining Motherworthy. Based in a reparations framework/mindset, this is my contribution to BIPOC mothers struggling on the front lines and navigating the intersectionality of their identities. I see you, and I greatly value your presence in this space and contribution to this experience.


1.

Do you consider yourself a Black, Indigenous, Latinx, Asian or mixed-race mother?

2.

I am offering the following Equity Seat payment options for MotherWorthy: $200 p/m, $150 p/m, $75 p/m, $25 p/m. Which option are you requesting?

3.

Do you have any comments, concerns, or questions about participating in MotherWorthy as a BIPOC mother?

4.

If it is possible, would you like to join a group with other BIPOC mothers?

5.

Your name, please?

6.

Your email address, please?

7.

Important Note

*Important Note: Once you've submitted this application, you will be hearing back from my team one way or another. Please check your spam folder if you don't receive a response by Sep 30th.

Click "Save Worksheet" below to submit your request.

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