Empowerment Academy Signature Program Application
Name
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First Name
Last Name
Age
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Date of birth
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Mailing address
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City
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State
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Zip code
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Email
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Phone
Social media handles
Personal or business website
What is your highest level of education received?
List pageant systems in which you have participated:
Are you registered or have plan to register for a pageant or major life goal within the next year? If so, list dates and details here.
List titles and awards received:
If you were referred to the program, please list their name here:
What are your talents (performance and non-performance)?
What are your pageant and/or life goals for the next 6-12 months?
Why do you want to become an Empowerment Academy Signature Program Delegate?
Please describe any accommodations you may need:
Name of parent or legal guardian (if under the age of 18)
Contractual Agreement for Participation
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I have read the Contractual Agreement for Participation, and agree to abide by the rules as set forth by the Empowerment Academy. I will pay the $350 registration fee via Venmo to @Darcy-Castro promptly.
Signature
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Submit
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