Being The CEO of ME Youth Entrepreneurship & Career Readiness Enrichment Program: 2023-2024

Being The CEO of ME Youth Entrepreneurship & Career Readiness Enrichment Program: 2023-2024

We welcome you and your children to our Being The CEO of ME Afterschool and Out-of-School Time Program where we help inspire students to learn, earn and explore through youth entrepreneurship, college and career readiness. This application is designed to assist us with the information to place your child in the right group and gather information for them to have a wonderful and transformative experience with Metamorphasis Powerhouse Company and our partners. Once you complete this form and provide the documents that are required, our team will review and notify you of your completion of registration. Please note: Your registration fee per family of $35 is due once you complete this application. The registration fee is nonrefundable.
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Student Information
Student Name*

First NameLast Name
Date of Birth*
Month/ Day/ Year
Student School ID #*
If student attends a homeschool cohort or co-op enter "homeschool"
Name of school student currently attends*
Student Current Grade Level for this school year 2023-2024*
County of Residence
Did anyone refer you to this program? If so, what is their name or organization name?
Do you have any other children that you would like to enroll into one of our programs?
Parent/Guardian Information
Mother/Guardian Name*

First NameLast Name
Work/Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Father/Guardian Name*

First NameLast Name
Work/Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address where student lives*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information & Medical
If parents cannot be reached, list nearby persons who will assume responsibility for your children

First NameLast Name
Please select which applies to your child for their known medical history

AsthmaADHA/ADHD/ADDAutism/ Neurodivergent SpectrumCancerDiabetesPhysical DisabilitySeizure DisorderSickle Cell AnemiaOther
Does your child take any prescribed medication routinely, that may need to be administered while participating in the program?
Does the student have any known allergies and/or adverse reactions to medications or foods?
Being The CEO of ME School/Community Site Registration*
My student will participate on*
Do you have reliable internet to participate in activities that are web-based and online? *
What type of device will the student be using to log in and participate each week inside our Google Classroom (windows, Android, iOS, chromebook)? *
Is there any important information you would like share about your child’s preferred learning styles, requirements or habits? *
My student needs additional help in the following academic areas:

ReadingMathScienceOther
Does the student have access to this device year-round, and are they able to use it consistently for class? *
Afterschool Enrichment Transportation Plans*

School Sites: My student will be picked up at 5pm afterschoolCommunity Sites: My student will be picked up at 7pm afterschoolMy student needs transportation afterschool to site partner (Boys & Girls Club only)Other
Preferred Camp or Afterschool Cohort Start Date *

MonthDayYear
Date
How did you hear about the program? (check all that apply)

My schoolMy faith-based institutionMy community centerSocial Media- FacebookSocial Media- InstagramReferral from a family member, friendCompany WebsiteFlier in a local businessChamber of CommerceReferral from a community partner (example: United Way of Greater Atlanta, SCWIB)Community EventOther
Share any previous or current business experience for this student*
[Existing Kid Business Owners] What product(s) and/or services do you currently offer?
Does this kid run business have a website?
[Existing Kid Business Owners] What type of ongoing supports would you like for an existing kid-run business (mark all that apply)

Website & SEO supportE-commerce supportBrand deals/ Public Relations supportBanking & Investor RelationshipsSourcing Materials supportTaxes & Business Infrastructure supportMarketing supportCommunications & Public Speaking supportKid Author supportWholesale Sourcing & Inventory supportLogistics & Operations supportPodcasting supportEvents & Engagements
Workshop/ Afterschool Registration

Choose which workshop, camp, or activity you would like your student to participate in
What is My Brand Cohort: Being The CEO of ME Prodigy [3rd-5th grade]
What is My Brand Cohort: Being The CEO of ME Apprentice [6th-8th grade]
What is My Brand Cohort: Being The CEO of ME Entrepreneur [9th-12th grade]
Transformation Team Cohort [Engineering Design Challenge] : 3rd Saturdays 9am-11am Students will help co-design a state-of-the-art Mobile Library on wheels. (Kicks off November 2023 | 9-12th grade only)
What is a Business Cohort: Being The CEO of ME Prodigy [3rd-5th grade]
MPC Kidpreneur Cohort: Unlocking E-commerce & AI Workshop Series
Summer Camps
Beta Testing My Product Summer Camp Intensive (Middle School & High School Only) June 3-7, 2024 Henry County
Beta Testing My Product Summer Camp Intensive (Middle School & High School Only) Summer June 10-14, 2024 Clayton County
Beta Testing My Product Summer Camp Intensive (Middle School & High School Only) Summer June 17-21, 2024 Macon-Bibb County
Being The CEO of ME Project SMART Summer Camp Intensive (Middle School Only) Summer June 24-28, 2024 Fayette County
Tuition Scholarship Opportunities

Please note: tuition scholarships are limited, and are provided by a case-by-case basis and only made available when grant funds have not been exhausted. Priority will be given to students who demonstrate financial, academic need and consistently attend programming.
My student currently receives the following benefits:

TANF/SNAP/Medicaid/SSICAPSFood StampsWICFree/Reduced LunchOther
Student Learning Loss Scholarship Application & Completed Forms- File Upload (Limited Funded Scholarship; In-Person Afterschool Enrichment Students Only)

DFCS United Way Learning Loss Scholarship Fillable English Form: (Directions: Copy + Paste link in browser/Complete Form + Save to computer/Upload) https://drive.google.com/file/d/11im3BaIOsZ5dMJwIakklJ_S1hd457dkI/view?usp=sharing ----------------------------------------------------------------------------------------------------------------- DFCS United Way Learning Loss Scholarship Fillable Spanish Form: (Directions: Copy + Paste link in browser/Complete Form + Save to computer/Upload) https://drive.google.com/file/d/1Un__DpLwTHU1T1RlNhyq3Sqq1zqwPima/view?usp=sharing
Cancelof
Learning Loss DFCS Scholarship Eligibility: What are the youth eligibility requirements for Learning Loss funding through MetIncPowerCo? To be eligible, youth must:  Be a U.S. citizen or legal immigrant;  Be a Georgia resident;  Currently receive Supplemental Nutrition Assistance Program (SNAP)/Food Stamps, Temporary Assistance for Needy Families (TANF), Medicaid or Supplemental Security Income (SSI) or have a household income 300% or less of the Federal Poverty Level (FPL);  Be 5 - 17 years old or be 18 years old and currently enrolled in school (high school, GED program or equivalent, or post-secondary institution) and will be enrolled in AND attend school during the upcoming academic year (verification of school enrollment includes a letter from the school on official school letterhead) or be 18 - 19 years old and have a dependent child AND be the custodial parent. ---------------------------------------------------------------------------------- If you are applying for a student scholarship, Type "I UNDERSTAND" in the box below
As the parent/guardian of student name I understand the Being The CEO of ME Youth Entrepreneurship & Career Readiness Program by Metamorphasis Powerhouse Company is an optional program, where my student's success will largely be benefited from my son/daughter's regular attendance, willing to be coached and mentored, and execution of all assignments and projects. I understand that my student's enrollment in the program is subject to following code of conduct standards including but not limited to the academic standards, internet policy, social media use policy, and anti-bullying policy.

By participating in the Being The CEO of ME program, I understand that I am giving my express permission for my son/daughter, student name to be filmed, photographed, and streamed online, on websites and social media pages pertaining to the Being The CEO of ME program, including but not limited to during virtual, and in-person workshops, field trips and events.
Parent Volunteering
I am interested in volunteering:

Field Trip/ Community Learning Lab Chaperone (3rd Saturday/month)Business MentorKID CEO Marketplace (Quarterly)Pitch Perfect SharkTank (Quarterly)Entrepreneur/ Small Business Shadow DayParent Engagement/ Parent University (Quarterly)Fundraising Committee (help keep the program low cost or free)Communications Committee (help send emails, text alerts, etc)Other
Registration Fee

A one-time family registration fee will be assessed every cohort. This fee helps offset the cost of administrative fees assessed to the program included but not limited to background checks, permits, licenses, program supplies, processing applications, etc.
Family Registration Fee (non-refundable) *
Being The CEO of ME Program SWAG

Optional program merchandise serves as an ongoing fundraiser donation to the program to help offset tuition, provide scholarships, and offset the cost of field trips throughout the year. Additional merch can be found on our Store at www.metincpowerco.myshopify.com
Being The CEO of ME Program Add-ons *
prevnext( X )
Being The CEO of ME Enrichment T-Shirt
$20.00 SizeQuantity



Being The CEO of ME Entrepreneur Big Ideas Journal
$15.00 Quantity



Being The CEO of ME Dry Erase Get It Done Calendar
$20.00 Quantity



Total

$0.00
Acknowlegment of Weekly Program Fees

Weekly program fees ensures that Being The CEO of ME continues to be provided as a year-round afterschool and out-of-school program provided at multiple sites in 9 or 11 week cohorts that focuses on academic, entrepreneurship, STEM, Literacy and social/emotional development. Students participate in educational activities that enhance proficiency in areas such as business development, reading, communication, financial literacy, and STEAM. Throughout the program, students engage with small business and corporate leaders providing mentoring opportunities. The goal of the program is to equip students with real-world applications of entrepreneurship and college/career readiness that equip them to succeed. To ensure success of the program, weekly fees are assessed and due on Fridays unless otherwise specified. A payment link will be provided for your weekly program fee during orientation. Failure to make payment may result in removal of the program.
Signature*

Clear
Confirmation: By Acknowledging and signing this form, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.

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Being The CEO of ME Youth Entrepreneurship & Career Readiness Enrichment Program: 2023-2024

Student Information

Parent/Guardian Information

Emergency Contact Information & Medical

Workshop/ Afterschool Registration

Summer Camps

Tuition Scholarship Opportunities

Parent Volunteering

Registration Fee

Being The CEO of ME Program SWAG

Acknowlegment of Weekly Program Fees