{"id":7345,"date":"2026-06-18T10:57:11","date_gmt":"2026-06-18T14:57:11","guid":{"rendered":"http:\/\/youmakethedifference.com\/staging\/?page_id=7345"},"modified":"2026-10-13T20:48:07","modified_gmt":"2026-10-14T00:48:07","slug":"application-form","status":"publish","type":"page","link":"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/application-form\/","title":{"rendered":"Application Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7345\" class=\"elementor elementor-7345\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200001 e-flex e-con-boxed e-con e-parent\" data-id=\"a5200001\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-a5200002 e-con-full e-flex e-con e-child\" data-id=\"a5200002\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200003 elementor-widget elementor-widget-image\" data-id=\"a5200003\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"300\" height=\"300\" src=\"https:\/\/youmakethedifference.com\/staging\/wp-content\/uploads\/2026\/07\/2026-Empowering-Minds-Logo-5-300x300.png\" class=\"attachment-medium size-medium wp-image-7963\" alt=\"\" srcset=\"https:\/\/youmakethedifference.com\/staging\/wp-content\/uploads\/2026\/07\/2026-Empowering-Minds-Logo-5-300x300.png 300w, https:\/\/youmakethedifference.com\/staging\/wp-content\/uploads\/2026\/07\/2026-Empowering-Minds-Logo-5-150x150.png 150w, https:\/\/youmakethedifference.com\/staging\/wp-content\/uploads\/2026\/07\/2026-Empowering-Minds-Logo-5.png 500w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a5200004 e-con-full e-flex e-con e-child\" data-id=\"a5200004\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200005 elementor-widget elementor-widget-heading\" data-id=\"a5200005\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">Empowering Minds<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200006 elementor-widget elementor-widget-text-editor\" data-id=\"a5200006\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>An initiative of the You Make THE Difference Foundation<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a520000c e-flex e-con-boxed e-con e-parent\" data-id=\"a520000c\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a520000d elementor-widget elementor-widget-heading\" data-id=\"a520000d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">BRING EMPOWERING MINDS TO YOUR COMMUNITY<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a520000e elementor-widget elementor-widget-heading\" data-id=\"a520000e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Empowering Minds Community Application<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a520000f elementor-widget elementor-widget-text-editor\" data-id=\"a520000f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Tell us about your community, its strengths, its needs, and the local people prepared to lead this work.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a5200010 e-flex e-con-boxed e-con e-parent\" data-id=\"a5200010\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-a5200007 e-con-full e-flex e-con e-child\" data-id=\"a5200007\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;sticky&quot;:&quot;top&quot;,&quot;sticky_on&quot;:[&quot;widescreen&quot;,&quot;desktop&quot;,&quot;laptop&quot;],&quot;sticky_offset&quot;:118,&quot;sticky_parent&quot;:&quot;yes&quot;,&quot;sticky_effects_offset&quot;:0,&quot;sticky_anchor_link_offset&quot;:0}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200008 elementor-widget elementor-widget-heading\" data-id=\"a5200008\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Explore Empowering Minds<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200009 elementor-nav-menu__align-stretch elementor-nav-menu--stretch elementor-nav-menu--dropdown-tablet elementor-nav-menu__text-align-aside elementor-nav-menu--toggle elementor-nav-menu--burger elementor-widget elementor-widget-nav-menu\" data-id=\"a5200009\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;layout&quot;:&quot;vertical&quot;,&quot;full_width&quot;:&quot;stretch&quot;,&quot;submenu_icon&quot;:{&quot;value&quot;:&quot;&lt;svg aria-hidden=\\&quot;true\\&quot; class=\\&quot;e-font-icon-svg e-fas-caret-down\\&quot; viewBox=\\&quot;0 0 320 512\\&quot; xmlns=\\&quot;http:\\\/\\\/www.w3.org\\\/2000\\\/svg\\&quot;&gt;&lt;path d=\\&quot;M31.3 192h257.3c17.8 0 26.7 21.5 14.1 34.1L174.1 354.8c-7.8 7.8-20.5 7.8-28.3 0L17.2 226.1C4.6 213.5 13.5 192 31.3 192z\\&quot;&gt;&lt;\\\/path&gt;&lt;\\\/svg&gt;&quot;,&quot;library&quot;:&quot;fa-solid&quot;},&quot;toggle&quot;:&quot;burger&quot;}\" data-widget_type=\"nav-menu.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<nav aria-label=\"Menu\" class=\"elementor-nav-menu--main elementor-nav-menu__container elementor-nav-menu--layout-vertical e--pointer-background e--animation-fade\">\n\t\t\t\t<ul id=\"menu-1-a5200009\" class=\"elementor-nav-menu sm-vertical\"><li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8629\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/\" class=\"elementor-item\">Empowering Minds Home<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-8775\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/about\/\" class=\"elementor-item\">About<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8630\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/how-it-works\/\" class=\"elementor-item\">How It Works<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8631\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/first-identifier\/\" class=\"elementor-item\">First Identifier<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8632\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/burnout-immunity-system\/\" class=\"elementor-item\">Burnout Immunity System<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8633\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/application-form\/\" class=\"elementor-item\">Apply<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8643\"><a href=\"https:\/\/www.albertaagsocieties.ca\/empoweringminds\/\" class=\"elementor-item\">Empowering Minds Canada \u2197<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t<div class=\"elementor-menu-toggle\" role=\"button\" tabindex=\"0\" aria-label=\"Menu Toggle\" aria-expanded=\"false\">\n\t\t\t<svg aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--open e-font-icon-svg e-eicon-menu-bar\" viewBox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M104 333H896C929 333 958 304 958 271S929 208 896 208H104C71 208 42 237 42 271S71 333 104 333ZM104 583H896C929 583 958 554 958 521S929 458 896 458H104C71 458 42 487 42 521S71 583 104 583ZM104 833H896C929 833 958 804 958 771S929 708 896 708H104C71 708 42 737 42 771S71 833 104 833Z\"><\/path><\/svg><svg aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--close e-font-icon-svg e-eicon-close\" viewBox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M742 167L500 408 258 167C246 154 233 150 217 150 196 150 179 158 167 167 154 179 150 196 150 212 150 229 154 242 171 254L408 500 167 742C138 771 138 800 167 829 196 858 225 858 254 829L496 587 738 829C750 842 767 846 783 846 800 846 817 842 829 829 842 817 846 804 846 783 846 767 842 750 829 737L588 500 833 258C863 229 863 200 833 171 804 137 775 137 742 167Z\"><\/path><\/svg>\t\t<\/div>\n\t\t\t\t\t<nav class=\"elementor-nav-menu--dropdown elementor-nav-menu__container\" aria-hidden=\"true\">\n\t\t\t\t<ul id=\"menu-2-a5200009\" class=\"elementor-nav-menu sm-vertical\"><li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8629\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/\" class=\"elementor-item\" tabindex=\"-1\">Empowering Minds Home<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-8775\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/about\/\" class=\"elementor-item\" tabindex=\"-1\">About<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8630\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/how-it-works\/\" class=\"elementor-item\" tabindex=\"-1\">How It Works<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8631\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/first-identifier\/\" class=\"elementor-item\" tabindex=\"-1\">First Identifier<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8632\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/burnout-immunity-system\/\" class=\"elementor-item\" tabindex=\"-1\">Burnout Immunity System<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8633\"><a href=\"https:\/\/youmakethedifference.com\/staging\/empoweringminds\/application-form\/\" class=\"elementor-item\" tabindex=\"-1\">Apply<\/a><\/li>\n<li class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-8643\"><a href=\"https:\/\/www.albertaagsocieties.ca\/empoweringminds\/\" class=\"elementor-item\" tabindex=\"-1\">Empowering Minds Canada \u2197<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a520000a elementor-widget elementor-widget-text-editor\" data-id=\"a520000a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Need immediate help?<\/strong><br>Empowering Minds is not a crisis service. Call or text 988 in the United States for immediate crisis support.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a5200011 e-con-full e-flex e-con e-child\" data-id=\"a5200011\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-a5200012 e-con-full e-flex e-con e-child\" data-id=\"a5200012\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200013 elementor-widget elementor-widget-heading\" data-id=\"a5200013\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">About this application<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200014 elementor-widget elementor-widget-text-editor\" data-id=\"a5200014\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div>The <b>Empowering Minds Community Application<\/b> is designed for communities, agricultural organizations, fairs, civic groups, schools, organizations rooted in faith, and local partners interested in hosting the Empowering Minds initiative.<br aria-hidden=\"true\" \/>This application helps us better understand your community, its unique strengths and challenges, and your readiness to engage in a meaningful community wellbeing effort focused on prevention, connection, and early intervention.<br aria-hidden=\"true\" \/>By completing this application, you will:<\/div><ul><li>Share information about your community, organization, and local leadership capacity.<\/li><li>Identify the challenges and opportunities impacting mental health and wellbeing in your community.<\/li><li>Confirm logistical details such as venues, local partnerships, outreach capabilities, and event support.<\/li><li>Describe the outcomes you hope to achieve through Empowering Minds.<\/li><li>Outline how your community plans to sustain momentum and impact beyond the initial program.<\/li><\/ul><div>Empowering Minds is built on a simple belief: <b>all things begin with well human beings.<\/b> Strong communities are built by equipping local leaders and everyday citizens to recognize when someone may be struggling, engage in supportive conversations, and connect people with appropriate resources before challenges become crises.<br aria-hidden=\"true\" \/>Your responses will help us assess your community&#8217;s readiness and identify how Empowering Minds can best support your local goals. Please answer each question as thoroughly as possible while keeping responses concise and focused.<br aria-hidden=\"true\" \/>We appreciate your interest in creating a healthier, more connected, and more resilient community.\u00a0<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a5200015 e-con-full e-flex e-con e-child\" data-id=\"a5200015\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200016 elementor-widget elementor-widget-heading\" data-id=\"a5200016\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Community Application<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a5200017 elementor-widget elementor-widget-text-editor\" data-id=\"a5200017\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Fields marked with an asterisk are required. Please answer thoughtfully and keep responses concise.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a520000b elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"a520000b\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Empowering Minds Application\" aria-label=\"Empowering Minds Application\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"7345\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"a520000b\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"You Make The Difference\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_4b89055 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Section A\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-organization elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-organization\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOrganizational Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[organization]\" id=\"form-field-organization\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-fname elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-fname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[fname]\" id=\"form-field-fname\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-lname elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-lname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[lname]\" id=\"form-field-lname\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-role elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-role\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPerson's Role\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[role]\" id=\"form-field-role\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-phone elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-phone\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[phone]\" id=\"form-field-phone\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-community elementor-col-70 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-community\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCommunity Name \/ Municipal Region\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[community]\" id=\"form-field-community\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-state elementor-col-70 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-state\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tState \/ Province\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[state]\" id=\"form-field-state\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"State or province\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_ae434f8 elementor-col-30 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ae434f8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPopulation (approx.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_ae434f8]\" id=\"form-field-field_ae434f8\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" min=\"1\" max=\"1000000\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_80d3371 elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_80d3371\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6Ldv8lgrAAAAAKtayMrUz9ByY6JNwQS4Yw9dqR_E\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_c900252 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Section B\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-whyEM elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-whyEM\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhy does your community want to host the Empowering Minds initiative? (2 to 3 sentences)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[whyEM]\" id=\"form-field-whyEM\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-whatChallenges elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-whatChallenges\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat mental health challenges or concerns does your community face? (brief context)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[whatChallenges]\" id=\"form-field-whatChallenges\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-readiness elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-readiness\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAgricultural Society\u2019s ability: Rate your readiness to lead (1 to 5) and challenges anticipated (e.g., volunteer capacity, outreach, staffing).\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[readiness]\" id=\"form-field-readiness\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_1be53a0 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Section C\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-committee elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-committee\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLocal Organizing Committee: Who will be involved? (roles or small names list)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[committee]\" id=\"form-field-committee\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-awarenessCampaign elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-awarenessCampaign\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAwareness Campaign Plan: Do you have capacity for social media, local storytelling, or communications?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[awarenessCampaign]\" id=\"form-field-awarenessCampaign\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-venue elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-venue\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVenue Availability: Do you have access to space for leadership training, youth sessions, and supper event?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[venue]\" id=\"form-field-venue\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-food_cost elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-food_cost\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCommunity Supper:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-food_cost-0\" name=\"form_fields[food_cost]\" required=\"required\"> <label for=\"form-field-food_cost-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-food_cost-1\" name=\"form_fields[food_cost]\" required=\"required\"> <label for=\"form-field-food_cost-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-delivery_date elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-delivery_date\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDelivery Dates or Timing Preferences (optional)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[delivery_date]\" id=\"form-field-delivery_date\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_e26c016 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Section D\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-achievement elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-achievement\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat would you like to achieve in your community? (e.g., reduce stigma, engage youth, build First Identifiers)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[achievement]\" id=\"form-field-achievement\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-momentum elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-momentum\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow will you sustain the momentum after the initiative? (e.g., ongoing community conversations, incorporating learnings)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[momentum]\" id=\"form-field-momentum\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-final_questions elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-final_questions\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAny other comments, needs, or questions?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[final_questions]\" id=\"form-field-final_questions\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-md\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit Application<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f83267cc elementor-widget elementor-widget-html\" data-id=\"f83267cc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script class=\"em-state-prefill\">(function(){function fill(){var p=new URLSearchParams(window.location.search).get(\"state\");var f=document.querySelector(\"#form-field-state\");if(p&&f&&!f.value){f.value=p.replace(\/-\/g,\" \");f.dispatchEvent(new Event(\"input\",{bubbles:true}));f.dispatchEvent(new Event(\"change\",{bubbles:true}));}}if(document.readyState===\"loading\"){document.addEventListener(\"DOMContentLoaded\",fill);}else{setTimeout(fill,0);}})();<\/script>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Empowering Minds An initiative of the You Make THE Difference Foundation BRING EMPOWERING MINDS TO YOUR COMMUNITY Empowering Minds Community Application Tell us about your community, its strengths, its needs, and the local people prepared to lead this work. Explore Empowering Minds Need immediate help?Empowering Minds is not a crisis service. Call or text 988 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":7140,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"class_list":["post-7345","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Application Form - You Make The Difference<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Application Form - You Make The Difference\" \/>\n<meta property=\"og:description\" content=\"Empowering Minds An initiative of the You Make THE Difference Foundation BRING EMPOWERING MINDS TO YOUR COMMUNITY Empowering Minds Community Application Tell us about your community, its strengths, its needs, and the local people prepared to lead this work. Explore Empowering Minds Need immediate help?Empowering Minds is not a crisis service. 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