Skip to main content
Girl Impact
Youtube
Instagram
Linkedin
Home
About
Founder’s Message
Program & Workshops
Girl Impact Speed Mentorship
Cohort 1 – Speak For Impact
Cohort 2 – Nurture Your Wellness
Inspire Her Journey
Get Involved
Cohort 3 Registration Form
Be a Volunteer
Partner With Us
Our Impact
Resources
Contact
X
Register for cohort
Personal Information Section
Name
*
Age
*
Phone
*
Email Address
*
Date of Birth
*
What grade are you in?
*
Street Address
*
Emergency Contact Information
Emergency Contact Name
*
Emergency Contact Phone Number
*
Photo & Video Consent
*
Girl Impact occasionally takes photos and videos during programming to celebrate participants and share our impact with the community. Do you consent to your child being photographed or recorded during the program?
Yes
No
Accessibility & Support
Transportation accomodation
*
This program offers free transportation to and from the program space. Will you require transportation accommodations?
Yes
No
Attendance
*
This is an 4-week program running from August 4th to August 27th. Sessions will be held once a week on either Fridays or Saturdays. Are you able to commit to attending all sessions?
Allergies & Dietary Restrictions?
*
Do you have any allergies or any dietary restrictions?
About you
Rate your skills
*
On a scale of 1–10, how would you rate your public speaking and overall communication skills? (1 = I lack confidence speaking in front of others and often have difficulty expressing my thoughts clearly. 10 = I feel very confident speaking in front of others and can easily communicate my thoughts and ideas.)
0
1
2
3
4
5
6
7
8
9
10
Program Goals
*
Imagine it's the last day of the program. What skills, confidence, or personal growth do you hope to have gained? How do you hope your communication and public speaking skills have improved?
Register
