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  • ABOUT C.H.A.N.G.E.
    • THE C.H.A.N.G.E MANTRA
    • Founders' Passion
  • Programs
  • Volunteer
  • Contact Us/inquiries
 2017
C.H.A.N.G.E. CAMP EMPOWER
Program ​REGISTRATION


    Program Application (June 26, 27 & 28, 2017) Elizabeth City, NC 

    ​REGISTRATION DEADLINE: Monday, June 12, 2017 (New Deadline)
    REGISTRATION FEE DEADLINE: Friday, June 16, 2017
    Registration Fee is $25.00 (may be paid via check or via PayPal)

    Payment may be sent via PayPal.com to change1enterprises@gmail.com

    . 

    Please indicate your t-shirt size.

    Parent/Guardian Information

    If you do not have an e-mail address, please input the following: noemail@address.org
    Check All that Apply

    Adult Recommendation (Family Member, Family Friend, Community Leader, etc)

    Adult Recommendation can be a Family Member, Community Leader, etc.
    If the answer is no, please write N/A. If the answer is yes, please explain the behavioral issue(s) here.

    All Applicants Must Complete This Section

    List your hopes, dreams, desires, or even your summer or academic goals. We just want to know more about you!

    We want to know more about you so we can tailor the workshop, so come on tell us a little about YOU!
    PAYMENT INFORMATION
    Checks are payable to CHANGE Enterprises, Inc
    PayPal payments are to change1enterprises@gmail.com 
    Program Point of Contacts:
    change1enterprises@gmail.com
    Dr. Jametta Davis, 703-899-0482
    Shavonta Green-Floyd, 703-798-6303
    Melba Smith, 252-335-3985
    TO SUBMIT YOUR APPLICATION, PLEASE PRESS "SUBMIT" BUTTON BELOW. 
    If you make an error or need to amend the application, please e-mail us at change1enterprises@gmail.com.
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