A place to belong. A place to bloom.

Daisies Application
Would you like to join Diverse Daisies? Fill out this form and we will get back with you!
  • Please take a minute to review the questions below before you start filling in the form.
  • We strongly suggest that you fill this form out from a computer or large screen tablet/iPad.  It will be much easier!
  • If you have any questions, click HERE to send us an email.
"ABOUT YOU" SECTION
Please enter your name!
What is your nickname, if you have one?
Where do you currently live?
What is the city and state you currently live in?
What is the zip code of your current residence?
What is the name of your current school?
Please enter your email!
Please enter your home phone number!
Please enter your cell phone number, if you have one!
What country do you have citizenship?
What is your hometown?
Please provide your current parent/guardian name(s).
Where does your current parent/guardian live?
Parent/Guardian City, State
Parent/Guardian Zip
Please provide your current parent/guardian's phone number.
Tell us a little about you and why you would like to be a part of Diverse Daisies?
Tell us what you can contribute to the Diverse Daisies group!

 

REFERENCES

Please provide two references that are able to answer basic questions about you.

REFERENCE #1

Reference #1 Name
How long have you known this reference?
What is your relationship to this reference?
Reference #1 Phone
Reference #1 Email (optional)

REFERENCE #2

Reference #2 Name
How long have you known this reference?
What is your relationship to this reference?
Reference #2 Phone
Reference #2 Email (optional)

 

AGREEMENT TO PARTICIPATE FORM

Please click HERE to open the AGREEMENT TO PARTICIPATE form. You will need to read it then both you and your parent/guardian will need to sign the bottom of the form.

You have three choices for the AGREEMENT TO PARTICIPATE form:

  1. Bring your completed form to your first event.
  2. Mail it to: Diverse Daisies Foundation, 115 North 1st Street, Suite #3 Minneapolis, MN 55401.
  3. Scan the completed form and upload the file using the "select files" button below.
Select files...

 

Great work!  Please allow us two weeks for application processing. Thank you!

Thank You, Partners!

Our Partners help make our program even better for the girls!

        

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