Power Forward Youth Foundation — VISION Program Enrollment Application

Power Forward Youth Foundation — VISION Program Enrollment Application

Complete this application to share your student information, leadership responses, and commitments for the VISION Program.
Student Information
Student Name

First NameMiddle NameLast Name
Preferred Name
Grade
School
Date of Birth

MonthDayYear
Date
Student Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Student Email
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact (if different)
Student Profile
GPA
Favorite Subject
Career Interest
Extracurricular Activities
Part-time Job?
Reliable Transportation?
Short Answer Questions
These are the questions that help you select students.
Why do you want to be part of the VISION Program?
What are three goals you hope to accomplish this school year?
What is one challenge you want to overcome?
Who inspires you and why?
Tell us about a time you showed leadership.
What do you think it means to have good character?
If selected, how will you contribute to the group?
Parent Commitment
Parent Commitment Agreement
Electronic Signature
Date

MonthDayYear
Date
Student Commitment
Electronic Signature
Date

MonthDayYear
Date
Should be Empty: