EPIC's EmpowerU Cohort 2 Application for Participants

EPIC's EmpowerU Cohort 2 Application for Participants

Starting January 2025
Welcome to EPIC's EmpowerU Cohort 2 application!

EmpowerU values your commitment to personal growth and empowerment. This free online pilot program is designed to support your journey toward greater self-determination, self-advocacy, and self-discovery.

Our Mission:
Empowering neurodiverse individuals to navigate life confidently.

Our Purpose:
EmpowerU offers a year-long journey focused on self-determination, self-advocacy, and self-discovery. We help neurodivergent individuals set goals, make informed decisions, confidently express their needs, and positively impact their communities.

Participant Agreement:

I acknowledge and agree to the mission and purpose of EPIC's EmpowerU

Commitment to Growth:

I commit to personal growth and active involvement with my cohort.

Commitment to Respect for Others:

I commit to treating all participants and facilitators with respect and consideration.
Participant Personal Information
Name*

First NameLast Name
Date of birth*

MonthDayYear
Date
How do you identify? (Check all that apply)

I am neurodivergentI have a disabilityI am unsureI do not identify as neurodivergent or as having a disability
What is your gender? (ex male, female, transgender etc...)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email*
example@example.com

What are your interests?*
Hobbies: e.g., Sports, Arts, Music Passions: e.g., Technology, Environment, Education, Advocacy
What are your strengths?*
Academic Strengths, Interpersonal Skills, Technical Skills, Creativity and Innovation, Adaptability
What are your challenges?*
Academic Challenges, Interpersonal Skills, Time Management, Communication, Specific Situational Challenges
Tell us why you want to participate in EmpowerU?*
Expectations:, Learning Goals, Skill Development, Community Engagement, Personal Growth
Do you have any comments or questions for us?

Participant Personal Information