[Secure Form] EMPOWER 2023

Student’s First Name

Student’s Last Name

Student’s Preferred Pronoun(s)

Parent’s First Name

Parent’s Last Name

Phone Number

Student’s Age

Name of School

City of School

Grade Level

How did you hear about our EMPOWER Human Kindness program?

If other, please specify

Please answer the following questions. You can submit your answers by typing below, uploading a video, or uploading a document (PDF preferred).

How do you EMPOWER Human Kindness and serve others in your school or community? (Up to 750 words)

How would you continue to EMPOWER Human Kindness in your school or community if selected as our EMPOWER HUMAN Kindness Ambassador? (Up to 750 words)

Please upload your video or document (up to 50MB)

Click Here to Upload

Share a link to your video (YouTube, Vimeo, DropBox, Google Drive)

*Must be submitted by a parent if the student is under 18 years old at the time of submission.

You are required to fully review the Official Terms & Conditions of the EMPOWER program prior to submitting your initial application.