I Want To Join / Refer A Mom

Shine Together is a community of support for pregnant and parenting young moms, helping them realize their dreams—in school and in life.

Shine advocates coach young moms and help them get the resources they need to achieve their dreams and live their best lives, while they also work towards providing their child(ren) with the best environment and opportunities to grow and thrive.

The Shine family supports moms with the things they need to succeed in high school, college, and beyond—as well as helping them cope with the additional demands of motherhood.

We know it isn’t easy to be a parent—especially a young mom—and we’re here to help.

Select and fill out the relevant form below and we’ll be in touch within one business day.

Join a community of Advocates and moms like you who’ve got your back. You don’t have to do mom life alone. Just fill out the form below to get started!

Si necesitas ayuda con el formulario, tenemos Advocates disponibles que hablan español. Envía un correo electrónico a program@shinetogether.org

This field is hidden when viewing the form

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.

About You

Your Name(Required)

How Can We Reach You?

We would love to chat with you. How can we get in touch?
Please indicate if Home/Landline or Cell(Required)
Is the number shared a safe number to contact and leave a voicemail?(Required)

What's your situation?

Please let us know what your situation is so we can address it accordingly.
Are you pregnant or parenting?(Required)

If pregnant, what is the due date for your baby?

MM slash DD slash YYYY
Have you graduated high school?
Are you currently enrolled in school?

Shine currently has programs in the following communities: South Bay Area (San Jose, Santa Clara, Sunnyvale, Milpitas, etc.), City of Fresno, City of Sacramento, and Monterey County. Shine programs are facilitated by our partner organization Harmony at Home in Monterey County.

Please select the city closest to you.(Required)
Do you have a Case Manager/Social Worker/Home Visitor (from any program)?(Required)
If you selected yes for the above question, please choose which other service(s) you use? (mark all that apply):

Are you part of a child’s Village? Do you know a young mom or expecting mom who could benefit from taking part in Shine’s programs?

This field is hidden when viewing the form

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.

Prospective Participant Information

Does the participant know they are being referred to Shine?(Required)
Participant's Name(Required)

How can we reach the participant?

We would love to chat with them. How can we get in touch?
Please indicate if Home/Landline or Cell(Required)
Is the number shared a safe number to contact and leave a voicemail?(Required)
Is the prospective participant pregnant or parenting?(Required)

If pregnant, what is the due date for the baby?

MM slash DD slash YYYY
Has the prospective participant graduated high school?
Is the prospective participant enrolled in school?

Shine currently has programs in the following communities: South Bay Area (San Jose, Santa Clara, Sunnyvale, Milpitas, etc.), City of Fresno, City of Sacramento, and Monterey County. Shine programs are facilitated by our partner organization Harmony at Home in Monterey County.

Please select the city closest to them.(Required)
Do they have a Case Manager/Social Worker/Home Visitor (from any program)?(Required)
If you selected yes for the above question, please choose which other service(s) you use? (mark all that apply):

Referrer Information

Thank you for reaching out to us.
Your Name(Required)
Your Email Address(Required)