EmpowerMe Membership Enrollment Form

EmpowerHood Academy Membership Application

Thank you for your interest in joining the EmpowerMe Membership Program at EmpowerHood Academy! Please complete the form below to enroll as a member.

Applicant Information

Full Name *

Date Of Birth *

Address *

City/State/Zip Code *

Phone Number *

Email Address (N/A if you don't have one) *

Membership Type *

Monthly Membership - $20/a month
Annual Membership - $140/a year (Only pay for 7 months)

Membership Activities

As a member, you will participate in these monthly activities:

Mentorship Sunday: Meet with a community mentor for guidance and support. Discuss goals, challenges, and progress.
Conflict Resolution Workshop (2nd Saturday): Learn effective conflict resolution skills and strategies. Practice active listening and empathy.
Education & Job Training Session (3rd Saturday): Learn about career paths and job opportunities. Develop skills in resume-building, interviewing, and more.
Community Engagement Day (Last Sunday): Participate in community service projects. Build relationships with community members and peers.

Fun Days

Every 4 months, all members will enjoy a "Fun Day" activity, such as:

Visiting an amusement park
Exploring a museum or art gallery
Spending the day at a water park
Going on a hike or nature walk

Fun Days will be planned and led by EmpowerHood Academy staff and volunteers, designed for friendship, adventure, and lasting memories.

Emergency Contact Information

Full Name *

Relationship To Applicant *

Phone Number *

Consent and Signature

I agree to abide by the EmpowerHood Academy Code of Conduct and participate fully in all scheduled activities. *

Agree
Disagree

Signature *

Parent/Guardian Signature *

After you have completed you enrollment application someone will reach out within 24 hours or less to collect payment. We will reachout through the information you've provided.

If you have any questions, please contact EmpowerHood Academy staff via email at empwh.academy@gmail.com. We look forward to welcoming you to EmpowerMe!

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Membership Levels

Monthly membership: $20

Annual membership: $140 (Only paying for 7 months)

Pay for the annual membership and your teen will receive a swag kit which includes a custom t-shirt, custom drawstring bag, and custom water bottle.

What you'll gain

As a member of EmpowerHOOD Academy, you will participate in these monthly activities:

Mentorship Sunday: Meet with a community mentor for guidance and support. Discuss goals, challenges, and progress.
Conflict Resolution Workshop (2nd Saturday): Learn effective conflict resolution skills and strategies. Practice active listening and empathy.
Education & Job Training Session (3rd Saturday): Learn about career paths and job opportunities. Develop skills in resume-building, interviewing, and more.
Community Engagement Day (Last Sunday): Participate in community service projects. Build relationships with community members and peers.
Fun Days: Every four months, members enjoy a "Fun Day" activity for friendship, adventure, and lasting memories.

Community Impact

A program like this can have a significant positive impact on the Greensboro community. Here are some potential benefits:

Mentorship and Guidance: Mentorship Sunday provides individuals with the opportunity to receive guidance and support from experienced mentors. This can help participants set and achieve personal and professional goals, overcome challenges, and make progress in their lives.
Conflict Resolution Skills: The Conflict Resolution Workshop teaches effective conflict resolution skills and strategies, such as active listening and empathy. These skills are essential for fostering harmonious relationships within the community and can reduce tensions and misunderstandings.
Career Development: The Education & Job Training Session offers valuable information about career paths and job opportunities. Participants can develop essential skills like resume-building and interviewing, which can enhance their employability and career prospects.
Community Service: Community Engagement Day encourages participants to take part in community service projects. This not only helps build relationships with community members and peers but also fosters a sense of responsibility and pride in contributing to the betterment of the community.