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MPower Online Learning - External Application 2022 (1)
This is the application to submit your interest in MPower Online Learning services. Upon completion of this application, you will be contacted to set up a Zoom interview before enrollment is completed.
Hipster Name (The person that will be utilizing MPower Online Learning)
(Required)
First
Last
Parent/Guardian Name
(Required)
First
Last
Parent/Guardian Phone Number
(Required)
Parent/Guardian Email Address
(Required)
Enter Email
Confirm Email
Best Way to Contact
(Required)
Email
Phone
What kind of technology does your Hipster have experience with? (Zoom, Facebook, Cell Phone, Tablet, etc)
(Required)
How did you hear about MPower Online Learning?
(Required)
via My Possibilities admissions process
Interested in My Possibilities Day Programming (in application process, toured previously, etc)
Other ongoing MP services (Therapy, Personal Training, Career Services)
Provider or Group Home
Alternate Adult Day Program
Other
Other
(Required)
MPower Online Learning services does not accept waiver-based funds, all enrollment fees are self-pay only at this time. Are you still interested in these services?
(Required)
Applying or enrolling in MPower Online Learning services has no bearing on admission, acceptance, or access to any other My Possibilities programs. By submitting this application, you are acknowledging that participation in MPower Online Learning WILL NOT impact any current status held with My Possibilities.
(Required)
Yes
No
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