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CANDIDATE INFORMATION

Complete this application to be considered for the 2024 EmpowerMEnt Leadership Institute cohort.

First Name

Middle Name

Last Name

Address Line 1

Address Line 2

City

Country

State

Provinces

State/Province

Postal Code

Student Cell Phone

Birthdate (MM/DD/YYYY)

School

Expected Graduation Date (YYYY)

Preferred Gender Pronoun

Parent/Legal Guardian Information

The parent/legal guardian information must accompany this application.

Prefix

First Name

Middle Initial

Last Name

Relationship to Student

Address Line 1

Address Line 2

City

Country

State

Provinces

State/Province

Postal Code

Direct Contact Number

How did you learn about the EmpowerMEnt Leadership Institute?

Have you previously applied for the EmpowerMEnt Leadership Institute?

YesNo

Did you complete a program year of the EmpowerMEnt Leadership Institute and receive a Certificate in Leadership?

Yes
No

Indicate highest Discipline completed:

Continuation Application Access Code (Discipline 2)

Continuation Application Access Code (Discipline 3)

Continuation Application Access Code (Discipline 4)

RESPONSES

Written Responses: Complete each of the following written responses. Keep it brief and real. Don’t be afraid to brag. We’ve kept the application fields short in order to encourage straightforward and authentic answers. Be confident and remember: You’ve got this!

Which of the world's "troubles" inspires you to act? How might your admittance in EmpowerMEnt prepare you to address it? (limit 175 words)

You can tie this response to community services activities, thoughts about empathy and individual responsibility. Why are you inspired to solve this problem? Why is it significant? This is an opportunity to demonstrate your values, critical thinking skills and creativity.

Discuss the most difficult feedback you've received. How did you address it? What did you learn from it? (limit 175 words)

Feedback isn't easy to hear. Describe the feedback you received. What made it difficult - what was said, who said it, who else heard it. Provide context. What did you learn from it? We can always improve. It's a sign of a great leader if you are willing to change.

What would you want your future college roommate to know about you? (limit 175 words)

What can you do today that you were not capable of a year ago? (limit 175 words)

Tell us a topic that you have changed your mind on in the last three years. (limit 175 words)

We know you lead a busy life, full of activities, many of which are required of you. Tell us something you do that makes you happy. (limit 100 words)

The following optional section can be used to share with the admissions committee additional information not covered elsewhere in your application.

Is there anything else you would like to share with the admissions committee?

Personal Video Statement: All applicants must submit a short video no longer than three minutes in length as part of the application process. Videos should include an introduction about yourself (be sure to include your full name, school, and grade). Give us your elevator pitch - your personal statement. What makes you unique? Why do you consider the leadership certificate program a good opportunity? Include your name, school, and grade in your video response (limit 3 minutes). Please upload your video to a video hosting service, like YouTube or Vimeo. Include the link and password (if applicable) below. Videos may be recorded on your phone or computer or with an external camera.

Video and Audio Tips:
Please film your video in a safe place and be especially mindful of local and national COVID-19 restrictions and safety protocols.
Film your video in a well-lit location, with the primary light source in front of you to illuminate your face, rather than behind you, which will cause silhouetting.
Film your video in a quiet space without background noises that might make your voice less audible. Avoid filming in loud, crowded, or windy places where your voice will echo and/or your microphone may be distorted.
Speak loudly and clearly, and review your video several times before submitting, making sure your voice is clear and can easily be heard.

TELL US MORE ABOUT YOU

Honors and Awards

List any honors or awards you have received.

Employment

List any employment experiences you have had.

EMPLOYMENT 1

Employer

Position

Hours Per Week

Dates

EMPLOYMENT 2

Employer

Position

Hours Per Week

Dates

REQUIRED DOCUMENTATION

Academic History

Transcript: Upload your full high school transcript.

Previous Year Final Report Card: Upload your 8th grade final report card.

Previous Year Final Report Card: Upload your 7th grade final report card.

Have you been found responsible for any:

Academic infractions (violations of academic integrity):

YesNo

Disciplinary infractions (behavioral misconduct):

YesNo

If marked yes, please elaborate:

Recommendation: The House, Inc. reflects its commitment to assess your potential as a member of EmpowerMEnt in its request for a recommendation. Include the name and information of an individual from a teacher, coach, family member, peer, or someone else to provide supporting information for your application and insight into how you are perceived by others. Recommendations should come from individuals who know you well and can reveal more about you than your application. This individual may be contacted to provide supporting information for your application.

Prefix

First Name

Last Name

Relationship to Applicant

Recommender Position/Title

Recommender Email Address

You may have additional recommenders submit letters of support by email to empowerMEnt@thehouse-inc.com with your name in the subject line.

APPLICATION SUBMISSION

The information in this application is true to the best of my knowledge. If selected, I understand the requirements described in the application and program details.

Submitting my application indicates my intent to enroll in the program, if selected.

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