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Program Registration Form

Welcome to Leaders In Transformational Education (LITE). We are excited you have chosen LITE and our amazing coaches to help you take steps toward your future. We are not a school but you will learn things that are not taught in school. We are a community nonprofit organization that is here to provide you with information, connections, and mentoring to reach your goals. Our programs are free and we provide snacks. Our programs also offer an opportunity to earn while you learn. We are here for you.

Please fill out the form below. You will be contacted by one of our LITE coaches to begin participation in a program where doors can open and opportunities are endless.
1.Today's date:(Required.)
2.Have you participated in LITE programs before?(Required.)
3.Name: First and Last(Required.)
4.Phone number:(Required.)
5.Home address:(Required.)
6.Email address:(Required.)
7.Please enter your birth date: (month/day/year)
8.Are you between the ages of 16 - 24?(Required.)
9.Please tell us how you identify(Required.)
10.Please select your Race/Ethnicity (select all that apply)(Required.)
11.Are you currently in school?(Required.)
12.What is the name of your school?
13.What is the highest grade you completed?(Required.)
14.What is your current employment status?(Required.)
15.If you are currently working, what is your job?
16.Please tell us about any additional jobs you had in the past 2 years.
17.Do you know what your dream job looks like?(Required.)
18.If you have your dream job in mind, please describe what that job looks like(Required.)
19.Which of our LITE programs do you have interest(Required.)
20.Consent for Promotional Purposes - permission to Leaders In Transformational Education (LITE) to use artwork, writing, testimonial, or pictures/video taken at this event or program for promotional purposes. I understand that refusal to sign this release will not affect delivery of service in any way. I am 18 years old or older/I am a parent or guardian of a child under 18 years of age.(Required.)
21.Transportation policy: I understand and agree to any policies, notices, and procedures regarding transportation provided by my organization and that I must arrive with and leave with the same transporter At no time will I leave an event with an unauthorized person. I /my child will stay with the group while at the event and be at the designated pick up and drop off locations at the assigned time. I understand and do not hold ay representative of LITE responsible for accidents or injuries in the event of an unforeseen incident and that me/ my child agree to abide by the rules set for transporting.

If LITE provides arranges for UBER or other ride share transportation and you/your child misses the ride, LITE reserves the right to no longer provide this service to events or programs for me/ my child

In the event the rules are not abide by, LITE may refuse to allow me/my child from participating in future off site events. LITE will only provide transportation for LITE clients that are registered and active in LITE programming. If you are not registered and an active LITE client you/your child must secure your own transportation. If offered I agree to the above and give permission for me/my child to take the transportation offered to the above mentioned event/program.

I am 18 years old or older/ I am a parent or guardian of a child under 18 years of age and have read and agree to the statements above. Please add your name below
22.I/my child dos not have a medical condition that I am aware of that prevents me/ my child from participating in this activity. I agree to hold Leaders In Transformational Education and any of its officers, employees, or volunteers free from any and all liability and waive all claims of damages or recompense for any accident, injury or disability to me or my property arising out of or connected with my participation in this activity/program/event. I also authorize the Chief Executive Officer of LITE, or duly designated representative, to secure the necessary medical service in the event of illness or physical injury to me/ my child during participation in LITE programs/ activities/ events. By providing your signature below you have read and agree to the statement above.
Thank you for completing this form. A LITE coach will contact you within 48 hours to greet you and provide introductions. We are looking forward to see you soon.