EmpowerWA - Schools Application

Contact Info

First Name *

Last Name *

Phone *

Email *

Date of birth *

School Name *

School Role *

How did you hear about us? *

Application Questions

EmpowerWA is designed for small cohorts of students and staff from a school and/or community to participate together. Ideally, this would be 3-5 students and at least one school staffmember, often a teacher, counselor, or administrator whom they have a solid relationship with. Groups of 6 or more students must have at least 2 adults with them. Special pricing for groups of 3 or more is available.

As a school staffmember, we encourage you to invite students who have influence on campus, including those who don't typically participate in traditional leadership groups. This experience can be a very powerful opportunity for those who have never seen themselves as a leader or considered themselves as a positive influence on others.

We may enroll individual students and/or educators who have participated in our past events on a case-by-case basis.

2025 Retreat Group & Educators Pricing

Solo Educator: $750
Educator + 3 students: $2,500
Educator + 5 students: $3,750

For each participant above 6 total, the cost will add $500 to the total.

Payment is not necessary to submit this form. We will reach out after your submissions to continue the process.

Planned Group Size

Funding Availability *

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

What is one specific skill or quality you'd like to develop at the retreat?

What is one significant challenge you are facing as an educator, and how do you think this retreat could help? *

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.

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

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