Dress for Success Cincinnati
Request for Services
Welcome to Dress for Success Cincinnati! The purpose of this intake form is to begin a trusted relationship together to tailor our programs in support of your needs. We realize that some of the following questions may feel private, but they are collected to assist in anonymous reporting to our grant funding partners who help us realize the Dress for Success mission and to ensure that we provide you with the best services possible.
Filing Out This Form


Referral Information
General Information




Address Information
Intake


Basic Needs
How Did You Hear About Us?


Demographic Information
PLEASE NOTE: The following questions will not affect your ability to participate in Dress for Success programs. The information requested is ONLY collected to aid in anonymous and aggregate reporting for grant funders who partner in the Dress for Success mission. Please let us know if you have any questions or concerns. We are here to help you. 


Household

Employment



Annual Household Income
Public Assistance

Please note that The Care Center - Loveland offers childcare during your appointment


Media Release
We want to celebrate you!

member of the DFSC team will be in contact with you soon for further assistance. 
File Upload
If you're requesting an employment appointment, please upload your employment verification (pay stub, schedule, offer letter, etc.).
Updated 4-13-2022