Survivor Form
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Please fill out the form entirely!

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EHN supports survivors of human trafficking who are ready to take their next step toward independence.

We currently focus on housing, education, and employment – but are always willing to pursue other gaps that exist in services if we can.

Nominee Information

Pick all that apply.

Financial Wellness

Empower Her Networks works to EMPOWER members to reach fiscal independence over the course of a 12-18 month time period, based on personal goals and aspirations. The following questions/ answers will be used as a baseline to help determine your best Financial Wellness Empowerment Plan moving forward!

Nominee Employment & Background Information

If not, unable to work reason
Enter the county that your address is in within your state
EHN believes that survivors are their own solutions. Our support comes in removing barriers and providing advocacy when necessary. With this in mind answer the following:
Information about your background and current life situation that is important for us to know
EHN is a trauma informed service provider that works through the survivor lens. What would you like to share that would be helpful for your advocate to know regarding your experiences, past or present that have the potential to cause emotional or mental distress often referred to as triggers.


You have an option of submitting a statement of interest to submit with this application. Tell us what you hope to accomplish with EHN! Attach Word document here.
Click or drag a file to this area to upload.

Additional Information

As an anti-trafficking organization EHN is often asked about the overlap in experiences of addiction, incarceration, child welfare and disabilities with experiences of trafficking.

If you feel comfortable, please answer yes or no to the following, so we can include you in relevant opportunities related to policy, advocacy, or eligibility for available financial benefits or changes in state laws that we are made aware of.

These answers have nothing to do with eligibility for our program, nor do they have any effect on your nomination. Any responses will be kept completely confidential.