EmpowerU: Student Enrollment
Welcome to EmpowerU! This training course resilience training will earn you a resume-building Resilience Certification, but more importantly, it will equip you with tools to renew you motivation and help you navigate you current and future challenges with more confidence and wellbeing.
Your first name
Your last name
What is the name of the advisor or the campus office that referred you to the EmpowerU Resilience Training?
What college/university do you currently attend?
We would like to share your completion progress with your college/university so they can validate your resilience certification as well as gather program data. Please check the box if you consent to EmpowerU sharing your completion progress and growth data with your college/university.
Yes, I consent to sharing of progress data with my college/university contact
No, I do not consent.
What is your cell phone number? (We will use this to communicate reminders for lesson completion)
What is the email you use most frequently? (We will use this to send important links and program information - so be precise)
What is your gender?
Prefer not to say
What is your race? (Check all that apply)
Southwest Asian/ Middle Eastern/ North African
Native American or Alaskan Native
Prefer not to say
What is your Ethnicity:
Hispanic or Latino
Not Hispanic or Latin
What year are you in college?
1st year college
2nd year college
3rd year college
4th year college
I understand that the training modules average 10 minutes a day and the pace of the training is one module per day for 11-12 weeks. Once I complete this form, I will receive an email and should start right away each school day.
Check all of your current stressors.
School or academics
Changes in his/her body
Negative thoughts or feelings about self
Unsafe living environment or neighborhood
Problems with friends and/or peers at school
Separation or divorce of parents
Chronic illness or disability
Moving or changing schools
Taking on too many activities or having too high of expectations
Future planning (e.g. going to college, career choices, etc.)
Is there a current official mental health or learning diagnosis that would be helpful for us to be aware of?
Thank you so much for completing this form. You will receive an email shortly with a link to get started right away.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service