Online Mom Power Group Pre-Registration

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We currently don't have any Mom Power groups planned. If you would like to be contacted if we organize Mom Power groups in the future, please complete this form.

Mom Power is a parenting empowerment program for moms. It meets once a week for 10 weeks. You'll have the opportunity to meet other moms and learn important parenting and self-care skills.

Mom Power is intended for people who identify as female, are age 18 or older, are pregnant or have children age 6 and under. Immigrants, refugees and all who live in Washtenaw County are welcome to attend. Registration priority is given to individuals who are eligible for Medicaid.

Attendance at group is important. Please only apply if you're committed to regular attendance.

Mother's Full Name *

Mother's Date of Birth *

YYYY

Mother's Ethnicity/Race (check as many as apply to you) *

Alaska Native or American Indian

Asian

Black or African American

Hispanic or Latinx

Middle Eastern or Arab American

Native Hawaiian or other Pacific Islander

White

Required

Street Address

City

Zip

Do you live in Washtenaw County? *

Yes

Phone number

Email address

The best way to contact you: *

CALL phone number

TEXT phone number

If it's easier to reach you by social media or by contacting an alternate number, please list that information below.

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