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PathMakers Program Application
PathMaker Version

Thank you for being interested in the PathMakers program.  We look forward to learning more about you and your interest in the program.

By providing a telephone number and submitting the form you are consenting to be contacted by SMS text message. Message & data rates may apply. Reply STOP to opt out of further messaging.

Phone Type
OK to leave messages?
OK to Text?
How did you hear about us?

Emergency Information

PathMaker Interest Information

The information you share will help us understand you better. Please be as detailed as you can. We will keep this information confidential.

Please let us know how you want to participate

Confidential Demographic Information

This information is helpful for our anonymous reporting to our funding sources and securing grant monies. 

Marital Status
Preferred Pronouns
Are you in need of permanent housing?
Are you homeless?
What best describes your living situation?
Employment Status

We want to know how many people are impacted by our help, so we want to know how many people are in your household?

Household Income
Race Self-Identification: (Check all that apply):
Ethnicity Self-Identification: (Check all that apply):
Do you or anyone in your family receive?
Do you or anyone in your family receive subsidized:

Policies and Releases

Photo/Video/Media Release*

I hereby grant WE CAN, its successors and assigns and those acting under its authority, and those for whom it is acting, the absolute right, for as often as it may elect, to copyright and/or use and/or publish any media pictures/video/media of me or in which I may be included in whole or in part, or in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any media for outreach, education, advertising, trade, or any other lawful purpose whatsoever.

I hereby waive any right that I may have to inspect and/or approve the finished product or the advertising copy that may be applied. I understand that under no circumstances shall I have any right to maintain any cause against WE CAN, or anyone else by virtue of the terms of this agreement, or anything done pursuant hereto.

Confidentiality Policy*

WE CAN is committed to making this a safe space for all of us.

Our policy on confidentiality states that everything participants share with staff and volunteers is confidential unless a participant shares they are going to hurt themselves or someone else, or if a child, elder or disabled person is being abused or neglected.

Within our groups and workshops, participants will keep confidential all that is shared in the meetings. WE CAN staff reserves the right to ask a participant to leave our programming if we have reason to believe that the confidentiality of the group is violated.

Substance Use Policy*

WE CAN requires that a participant be sober and not use alcohol or drugs on the day of a walk in, appointment, workshop or group. This is necessary for WE CAN to provide a safe space for our programming and events and to support women in recovery as well as women who have been impacted by loved ones who have or had a substance use disorder.

If a participant appears intoxicated or under the influence of drugs, WE CAN will ask the participant to leave the group, workshop, appointment etc and arrange a sober ride home (friend, family, taxi) with assistance from WE CAN.  If a participant leaves the premises while driving a vehicle and appearing intoxicated/under the influence of drugs, the WE CAN staff/intern/volunteer must call the police to notify them with the participant’s name and a description of the vehicle. 

WE CAN staff and volunteers reserve the right to call local Rescue at 911 if we have serious concerns about a participant’s health (including intoxication/under the influence of drugs) to ask Rescue to make an assessment.

COVID Policy

Do not come to the WE CAN office if you are not feeling well or are experiencing any symptoms associated with COVID-19, including fever, cough, sore throat, shortness of breath, loss of taste or smell, nasal congestion, or runny nose. Contact us at WE CAN to let us know and and stay home.


Anyone who begins to feel ill during the program should tell the WE CAN staff, and leave the building. If unable to drive, their emergency contact will be notified. 

Office protocols will continue to be updated on an as-needed basis, depending on evolving public health circumstances and guidance from the federal, state, and local government. These protocols may involve masks, distancing, or other precautions as needed. 

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