EmpowerWA - Student Application

Contact Info

First Name *

Last Name *

Phone *

Email *

Date of birth *

School Name *

Anticipated Graduation Year *

Parent / Guardian Phone *

Parent / Guardian Email *

How did you hear about us? *

Application Questions

Why do you want to participate in the Empower WA Leadership Retreat? *

What does leadership mean to you?

How do you currently contribute to your school or community?

What specific skills or qualities do you hope to develop during the retreat?

What is one challenge you face as a young leader, and how do you think this retreat could help?

Participation Type *

Consent & Submission

EmpowerWA is committed to creating an inclusive and welcoming environment for all participants. We do not discriminate based on race, color, ethnicity, national origin, religion, gender, gender identity, sexual orientation, disability, or any other legally protected status.

Applications will be reviewed based on the quality of responses and the availability of space in the program. While we strive to accommodate as many applicants as possible, spaces are limited, and not all applicants may be selected.

Please note that there is a fee required to participate. If you application is approved, we will reach out to you and your guardian for payment to secure your space. Payment is not required to submit this form. Students participating with a sponsored school group are considered paid in full. Limited scholarships and need-based sponsorships are available.

Thank you for your interest in the Empower WA Leadership Retreat. We look forward to reviewing your information.

Payment and Sponsorship

I acknowledge the above terms and I consent to receive email and SMS notifications, alerts & occasional marketing communication from company. Message frequency varies. Message & data rates may apply. Text HELP for assistance or reply STOP to unsubscribe at any time.

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