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Required fields are marked with an asterisk (*). Client First Name *
Client Last Name *
Client Mobile Phone
Have you had a Covid-19 Vaccination? (This question is for statistical purposes only, client will receive services regardless of vaccination status)
Suiting Program Clothing Need (please select one)
Interview Date (for interview suiting) or Start Date (for employment suiting):
A valid date as MM/DD/YYYY (for example: 11/30/2015)
Company
Position
PART 1: REFERRAL AGENCY INFORMATION (If you are not an referral agency partner please type AUTO REFERRAL DFSSN under agency name and skip the remainder of this portion - Part I and Go straight to Part II Client).
Agency Name (If this is a self-referral please type: SELF REFERRAL DFSSN)
Contact Name
Contact Phone
Email Address
PART 2: CLIENT INFORMATION
Mailing Address
Apt #
City
State
ZIP
Client Phone Number
Birthdate *
A valid date as MM/DD/YYYY (for example: 11/30/2015)
Client Email Address
Ethnicity
Education Completed
Marital Status
# of Children
# of Children Under 18 Yrs
Are children in your care?
Time Searching for Work
Have you (client) served in the military?
Select One Or More If Applicable
Currently receiving public assistance (e.g., food stamps, public housing)?
Transportation
Fashion Style:
Body Type:
Height:
Select suiting size
Blouse Size:
Bra Size:
Favorite Color:
Select Shoe Size *
Preferred Shoe Height
Pierced Ears?
What would you feel most confident and comfortable wearing to a job interview or on the job? Check All that Apply: *
Are you willing to try something new, perhaps a bit outside of your "comfort" zone to broaden your styling options and expand your wardrobe? Please Explain:
If possible, we ask that after completing this form you also send a head-to-toe photo of the client to: referralagency@dfssouthernnevada.org
A photo of the client is not mandatory to receive services, however it is very helpful to our stylists. Selecting clothing items in a contactless “sight unseen” environment requires care, creativity and accuracy. It is VERY IMPORTANT to obtain as much information as possible to curate the most flattering wardrobe for the client's size & shape, and a photo is extremely helpful.
I (the CLIENT) AGREE that Dress For Success Southern Nevada and/or their assigns may use my Images and voice with respect to Dress For Success Southern Nevada, to include use in internal display, social media, broadcast, marketing, advertising, promotional materials such as brochures and newsletters, and/or any other use DFSSNV deems valuable. I understand there will be no monetary compensation for my participation, and these Images may be used without further notifying me.
*This agreement shall be governed by the laws of the State of Nevada 2020.
Before/After Photo Consent (please select)
Boutique services, interview or employment suitings appointments are scheduled on TUESDAY, WENESDAY, and SATURDAY between 8:00am - 2:00pm. Clients must wear a mask when visiting the Dress for Success Southern Nevada. Kindly consider that due to space limitations ONLY clients or case manager are permitted at the boutique, we cannot accommodate additional person(s) / children and we appreciate your kind understanding.
Please arrive to your appointment on time. Our staff and volunteer Stylist /Personal Shoppers have made themselves available for you. Our goal is to provide you with the best possible service, our Stylist / Personal Shopper have gone through extensive training to style you, and select industry appropriate clothing that will have you dressed for success. Every effort will be made to find appropriate attire for you, however, we cannot guarantee complete outfit to everyone due to limited inventory, availability of specific sizes, colors and styles.
To notify us of delays and to re-schedule, please email referralagency@dfssouthernnevada.org or call 702-684-6412 Extension 104. A 24 hour cancellation notice is required. Thank you, we look forward to serving you.
Our clothing symbolizes our faith in every woman's ability to succeed, but in addition to our suiting program we offer a variety of progams and services to set you on the path to personal and professional success. How else can we support you at Dress For Success?
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