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Sponsor My Teen

For Parents or Guardians Seeking Sponsorship for Their Teen

Thank you for your interest in the Sponsor My Teen program. This application is for parents or legal guardians seeking sponsorship support for their teenager by a generous donor. Please complete all sections of the form carefully. The information provided will help us match your teen with a potential sponsor. All information is kept confidential and used solely for the purpose of this program.

Parent/Guardian Information

Full Name *

Relationship To Teen *

Primary Phone Number *

Email address *

Mailing Address *

Teen Information

Full Name *

Teens Age *

Teens Grade Level *

Teens School Name *

Teens Interest and Hobbies (N/A If you they don't have any) *

Teens Gender *

Teens Preferred Pronouns *

Household Information

This information is for EMPOWERHOOD ACADEMY ONLY and will not be porovided to any other organizations.

Number of People In Household *

• Does anyone in your household currently receive SNAP (Supplemental Nutrition Assistance Program) benefits? *

Yes
No
Prefer Not To Answer

Does anyone in your household currently receive Medicaid benefits? *

Yes
No
Prefer Not To Answer

Please describe any specific challenges or circumstances your family is facing that you wish to share with a potential sponsor (optional):

Teen Sponsorship Goals

What are your teen's hopes and dreams for the future? *

Is there anything specific you wish a sponsor could provide, such as tutoring, mentorship, extracurricular funding, or supplies?

Parent/Guardian Consent & Signature

By submitting this form, you confirm that all information provided is accurate to the best of your knowledge. Additionally, you consent to your teen being considered for sponsorship through the Sponsor My Teen program.

Please sign and date below.

Signature (By Typing Your Name In The Box Below You Acknowledge that it is equal to a written Signature.) *

Date *