Girls Impact
Youtube
Instagram
Linkedin
Home
About
Program & Workshops
Cohort 1 – Speak For Impact
Cohort 2 – Nurture Your Wellness
Inspire Her Journey
Get Involved
2026 Cohort 1 Registration
Be a Volunteer
Partner With Us
Our Impact
Founder’s Message
Resources
Contact
X
Register for cohort
Applicant Information
Full Name
*
Age
*
*Must be between 15 -19*
Date of Birth
*
Email Address
*
Phone Number
*
Street Address
*
Grade or Current Education Level
Emergency Contact Name & Relationship
Emergency Contact Phone Number
*
Getting to Know You
We want to know who you are beyond the form. Answer honestly!
What does being part of a sisterhood mean to you?
Girl Impact focuses on personal and professional development. Which of these areas do you feel you want to grow in most, and why?
What are some goals or dreams you have for yourself over the next few months?
What do you hope to gain from this experience, and what do you hope to contribute to others in the program?
The program requires attendance, participation, and engagement. How will you make sure you stay committed?
Program Commitment
This program is divided into three 8-week cohorts, each focusing on a key development theme within professional & Personal Development. Workshops will include mentorship sessions, group activities, and safe-space discussions. Your consistent presence is essential to building sisterhood and growth.
Are you able to commit to attending weekly sessions for the duration of your assigned cohort?
Select Option(s)
Yes
No
Unsure
Do you understand that this program requires active participation and respect for the shared space and community guidelines?
Select Option(s)
Yes, I understand
No
What day(s) of the week works best for you to attend the program?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
4. What support might you need from us to help you stay committed and engaged? (We offer transportation support, let us know if you'd need it, in your response)
Self-Identification
This section helps us understand and serve our community better. All responses are confidential.
How do you identify?
Afro-Caribbean
African
Multi Racial
Other
Prefer not to answer
Do you have any accessibility needs, allergies, or health concerns we should be aware of?
Do you have any dietary restrictions ?
Would you consider your household to be low-income?
Select Option(s)
Yes
No
Prefer not to answer
Which range best describes your household income?
Select Option(s)
Under $30,000
$30,000–$59,999
$60,000–$89,999
$90,000+
Prefer not to answer
Do you have a learning disability or learning difference we should be aware of?
Do you have any accessibility needs or accommodations you would like us to consider?
Parent/Guardian Consent
Required for participants under 18
I give permission for my child to participate in the InspireHER Journey Program (2026) organized by Girl Impact. I understand that participation involves attending regular sessions, workshops, and community events that support personal and professional development.
*
Select Option(s)
I consent to my child participating in the InspireHER Journey Program (2026).
I do not consent to my child participating in the program.
Parent/Guardian Name
*
Date
Parent/Guardian email
*
Parent/Guardian Phone Number
Media Release Consent
Girl Impact may take photos or videos during workshops or events to celebrate our participants’ growth and promote the program. These materials may be used on our website, social media, or promotional materials.
*
Please indicate your consent below
I consent to my photos/videos being used by Girl Impact.
I do not consent to my photos/videos being used.
Participant Agreement
By registering, I understand that: That Girl Impact is a safe and inclusive space where confidentiality, respect, and kindness are expected. I will show up fully, participate with intention, and communicate openly with the Girl Impact team. I recognize that this is a year-long opportunity for growth, learning, and impact.
I have read and agree to the Girl Impact Participant Expectations, and I commit to participating fully, respectfully, and with intention throughout this year-long opportunity.
Submit
