SHAPE Program Application

  • Date Format: MM slash DD slash YYYY
  • Parent / Guardian contact information

  • Program Questions

    Please answer each question as thoroughly as you can.
  • If selected following an interview, I understand that parental permission is required for my involvement. I will attend a multi-day training retreat (day & night) in June (free). I understand I MUST attend a 4-day (free) training camp in October. I acknowledge that I will be taken out of school on days I am scheduled to teach (up to 5 days). I agree to strive to teach without judgment. I will do my very best to fulfill my commitments to the program. PLEASE TYPE YOUR NAME BELOW TO SERVE AS YOUR SIGNATURE.

Please call or write Kathy Harms with any questions 405-503-7081 / kathyh@teenempower.org

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After submitting the application someone will call you to tell you whether or not you may be interviewed. Please call 405-503-7081 if you have questions.