Elevated Minds Application

Question Title

* 1. Contact information.

Name

What type of placement are you in? (Group Home, Foster Placement, Relative Placement , Living independently)

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. What grade are you in?

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* 3. About you

Birth Date

How old are you?

How many years have you spent in care?

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* 4. Adult supporter who would recommend you?

Name

Company/Agency

Would they be willing to assist you in your role?

Email Address

Phone Number

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* 5. Are you Dekalb/Fulton?

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* 6. What is Georgia EmpowerMEnt?

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* 7. If you could have any superpower, which would it be?

Flying

Super strength

Invisibility

Super speed

Reading minds

Time travel

Controlling the weather

Teleportation

Other

Elevated Minds Application

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* 1. Contact information.

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* 2. What grade are you in?

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* 3. About you

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* 4. Adult supporter who would recommend you?

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* 5. Are you Dekalb/Fulton?

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* 6. What is Georgia EmpowerMEnt?

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* 7. If you could have any superpower, which would it be?

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* 8. Why did you choose that power?

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* 9. What do youth in care need while in school?

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* 10. What makes you AWESOME? (More than 3 sentences)