Rise R.E.D. Participant Application

Full Name*

PrefixFirst NameLast Name

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Shirt Size*

Working?*

YesNo

Are you a single mother?*

If yes, How many children do you have?*

What is your highest level of education?*

College (other)*

Looking for a mentor*

yesno

What inspired you to join the RISE RED Initiative?*

What personal goals do you hope to achieve through this program?*

What PROFESSIONAL goals do you hope to achieve through this program?*

Describe any challenges you currently face in reaching your goals*

What does empowerment mean to you?*

Have you previously participated in leadership or empowerment programs? (If yes, please specify.)*

Which skills do you wish to strengthen most through this initiative?*

What type of support system do you currently have?*

What additional resources or support would you like to receive from RISE RED?*

Are there specific topics you would like to explore in greater depth (e.g., time management, financial literacy, career planning)?*

Are you able to commit fully to the 12-16 week duration of the program?*

Do you have regular internet access and a reliable device to attend virtual sessions if necessary?*

Please share any additional information or special needs you'd like the program facilitators to be aware of:*

Tell us why you should be chosen for the program,if you have already submitted this please write N/A*

How did you learn from us?*

FriendInternetMediaEvent

Rules for Participation:

Treat all participants and facilitators with respect.
Use respectful language at all times.
Confidentiality:

Do not share personal or sensitive information outside the group.

Actively participate in all sessions and activities.
Allow others to speak without interruptions.

Be on time for all scheduled virtual sessions.

Maintain respectful and courteous interactions at all times.
Avoid any offensive, discriminatory, or inappropriate behavior.

Ensure stable internet connectivity and appropriate devices for participation.

Address any feedback or concerns directly and privately to facilitators.

Consequences for Non-Compliance:
First violation: A private warning will be issued.
Second violation: Temporary suspension from participating in virtual sessions and chat room discussions.
Repeated violations: Permanent removal from the RISE RED Initiative with possible forfeiture of any program benefits or resources.

Interested in (mark all that apply):*

Do you consent to your testimonials, images, or success stories being used anonymously for promoting the RISE RED Initiative?By submitting this form, do you confirm that all the information provided is accurate and truthful?By submitting this form you agree to participation rules and consequences

Facial Photo*

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Signature*

Registration Form