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The Empowerment Fund Application
Organization
*
Advocate's Name
*
First Name
Last Name
Advocates Email
*
Advocate's Phone Number
*
Applicant's Name
*
First Name
Last Name
Applicants Email
*
Applicant's Phone Number
*
Was recipient trafficked as a youth?
*
Yes
No
If so, age trafficked?
*
select one
Infant
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Race
select one
White
BIPOC
Other
Gender Identity
*
Preferred Pronouns
*
Do you identify as LBTGQ
select one
Yes
No
Have you experienced foster care?
select one
Yes
No
School Information
School / Program Name
*
School / Program Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Course of Study
*
Approximate time to complete course of study?
*
Approximate cost
*
Tell us about yourself and why you are applying for this grant.
*
What are your education related goals?
*
What are your career goals?
*
Tell us about your support system
*
