Apply Now! | Empower Youth

Your future self thanks you for taking the initiative to EMPOWER yourself!

Please complete and submit the below form to apply for the Empower Youth leadership Program. The application deadline is April 18, 2018.

After submitting your application, you will receive an email from Empower Youth Coordinator Kristie Ching. The email will include consent forms that must be completed to finish the application process. Please email the completed consent forms to Ching at empoweryouth@bepc.com.

Student Information

Sponsoring Cooperative

Don't see your cooperative?

If you don't see your cooperative in the list above, please email empoweryouth@bepc.com. Do not fill out this form.

First Name

Last Name

Address

Address 2

City

State

Zip

Phone

Grade in 2018/2019

School

Shirt Size (Unisex):

Parent/Guardian

First Name

Last Name

Address

Address 2

City

State

Zip

Phone

Emergency Contact

Other than parent/guardian

First Name

Last Name

Emergency Phone

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