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1 YOU

2 YOUR WELL-BEING

3 YOUR MOTHERHOOD

4 YOUR CIRCLE

Get in here, mama

Ready to meet your Circle? Fill out the form below (shouldn’t take more than 15 minutes) and we’ll get to work. We'll notify you once we find your personalized micro-community of other moms going through it too. Then it's time to get real and get help. Please email us at hello@mothernation.com with any questions.

Help us get to know you
FIRST NAME*
LAST NAME*
EMAIL ADDRESS*
We consider your location when gathering Circles and use your home address to mail you MotherNation swag. We respect your privacy and will never share your information. See our privacy policy for more info.
HOME ADDRESS*
HOME ADDRESS (OPTIONAL)
CITY*
STATE*
ZIP CODE*
MOBILE COMMUNICATIONS*
I consent to MotherNation contacting me via my mobile number for the following purposes:
- To text me MotherNation event and meeting reminders
- To text me periodic affirmations and pep talks
- To connect me with my Circle members using a third party service (i.e., WhatsApp, Telegram or Signal)
- To seek feedback
- To check in between Circle meetings
- For administrative reasons related to my membership
- None - I do not consent to MotherNation contacting me via mobile.
Please note that you can unsubscribe from mobile communications at any time. See our privacy policy for details.
MOBILE PHONE NUMBER*
WORK*
Please select the statement that best describes your current work situation.
- I work for an organization.
- I do mostly freelance or contract work
- I do not work outside the home
- I own or am the CEO of an organization
- None of the above
How do you describe your work situation?*
JOB TITLE*
Your job title at home is mom. What is your job title outside the home?
GENDER
What gender do you identify as?
- Woman
- Gender Fluid
- Gender Nonconforming
- Man
- None of the above
RACE
What race(s) do you identify with?
- African
- American or Alaskan Native
- Asian
- Black or African American
- Latinx
- Middle Eastern
- Pacific Islander
- Southeast Asian
- White
- None of the above
How do you describe your gender?
How do you describe your race?

Get in here, mama

Tell us about your well-being

Knowing where you are today helps you set goals for tomorrow.
I take care of my mental health, including paying attention to how I am feeling and processing my emotions.
I nurture my physical body, including getting adequate sleep, eating healthy food, and moving my body in a way that feels good.
I devote meaningful time to my personal interests and hobbies.
I am a good mom.
I am a good employee.
I take my own values, goals and intuition into account when making decisions.
AT WORK: I ask for help when I need it.
AT HOME: I ask for help when I need it.
My coping strategies for stressful times are:
AT WORK: I feel stuck or unable to progress.
AT HOME: I feel stuck or unable to progress.
I feel connected to myself; I know who I am.
I feel like I can bring my whole self (all aspects of me, including my Motherhood) to work.
I feel lonely in my daily life.
I have a community that provides emotional support and motivation.
I consider reducing my hours or exiting the workforce.
Use the following scale: Never - Rarely - Monthly - Weekly - Daily
I supportively listen to others.
I clearly communicate with others.
AT WORK: I work smart: I use systems to evaluate and prioritize my responsibilities and keep clear boundaries to reinforce my efforts.
AT HOME: I work smart: I use systems to evaluate and prioritize my responsibilities and keep clear boundaries to reinforce my efforts.

Get in here, mama

Tell us about your Motherhood

This helps us place you in a Circle that best fits your needs.
How many children do you have?*
Please include any babies you are currently expecting.
Birthdates or due dates:*
MM
DD
YYYY
Second birthdates or due dates:
MM
DD
YYYY
Third birthdates or due dates:
MM
DD
YYYY
Fourth birthdates or due dates:
MM
DD
YYYY
Fifth birthdates or due dates:
MM
DD
YYYY
Please select any shared experience that you would like to connect with other Mothers about.
We know this list is not exhaustive so feel free to add in your own. And the universal experience of Motherhood offers plenty of connection so totally fine to skip this question 😊
- Raising kids with special needs
- Mothers of color
- Raising NICU/premature babies
- Infertility
- LGBTQ+ families
- Self-employed Mothers
- Interfaith families
- Pregnancy loss/miscarriage
- Twins/multiples Mothers
- Single/newly separated Mothers
- Foster families
- Multi-racial/multi-cultural families
- Adoptive Mothers
- Surrogacy
- Families in recovery
- Blended families
- Other

Get in here, mama

Your Circle
How important are the following statements to you?
I want to meet Mothers with kids the same age as mine.
I want to meet Mothers to connect over the shared experience selected above.
I want to meet Mothers in my area.
What is your main motivation for joining a Circle?
Select up to 2 options.
- Friendship
- Affirmation
- Community
- Empathy
- Solidarity
- Accountability
- Personal Growth
- Parenting Resources
What time zone are you in?*
- Eastern
- Central
- Mountain
- Pacific
Please select all times during which you are available to meet with your Circle.*
Circles will meet bi-weekly for 90 minutes. Please be as inclusive as possible and note any conflicts below.
- Weekday Lunchtime (11am-2pm)
- Weekday Evening (7p-10pm)
- Weekend Morning (9a-12pm)
- Weekend Afternoon (12-3pm)
Any specific scheduling conflicts or preferences you'd like us to know?
Anything else that we should keep in mind as we find your Circle?
Membership Terms*
I agree to the Member Agreement and the Declaration of Interdependence.

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💛 𝙀𝙫𝙚𝙧𝙮 𝙢𝙤𝙢 𝙬𝙖𝙣𝙩𝙨 𝙩𝙝𝙚𝙞𝙧 𝙗𝙖𝙗𝙮 𝙩𝙤 𝙩𝙝𝙧𝙞𝙫𝙚. Enough said.

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No matter how you fed or are feeding your children, you're doing an amazing job.

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