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Educationempowersstudents of allages to designtheir future.

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© 2017 Heartland Foundation. All rights reserved.1

Bringing together youth and adults from

throughout the heartland to lead change,

champion education, and help create

healthy and thriving communities.Heartland Foundation has recognized time and again overdecades the power of cross-sectorial and cross-generationalcollaboration. Other respected voices in today’s Americanculture agree with our experience. According to a recentarticle in The Huf�ington Post, “The best news is thatcross-generational collaborations can be extraordinarilypowerful…When the generations connect, their work isdramatically enhanced: more sustainable, more creative,more energized, [and] more connective.” The article goes onto say that young people tend to be more idealistic, greaterrisk-takers, technology literate, and creative thinkers, whilethe older generation brings valuable skills, a lifetime’s worthof personal connections, and leadership experience.

EXPLORE

ENGAGE

SHARE

CREATECREATE

imagine...... a leadership journey that challenges your in�luences, identi�ies your

core values, and ignites your dreams.• What is your dream life…really? What will it take to make that dream a reality?• How can you best fuel your journey through a cultural climate of fast-paced change?

imagine...... free space where you are empowered; working with intergenerational

leaders to ignite a movement that champions education.• Whose work is it to ensure every citizen values and has access to education frombirth throughout life?

• What can you discover through the exchange of ideas and experiences to setand prioritize actionable goals addressing those challenges?

imagine...... listening to a successful leader’s story of their real-life challenge

and collaboratively recommending how you would solve the struggle.• What happens when the challenge questions your ethics?• How do you work with a team to come up with a solution of integrity?

imagine...... beginning an expedition where you are the architect of the future.

• What does the structure of your desired future look like?Does it have a solid foundation and strong pillars?

• What happens when a storm weakens the integrity of the infrastructure?How can you be con�ident your choices now will help you withstand future challenges?

The e2 Fellowship Program aims to empower ourregion’s greatest potential for empowering others.

© 2017 Heartland Foundation. All rights reserved.2

WHO:• Teams fromMissouri, Kansas, Nebraska, and Iowa are invited to participate.• Teams of three (3) members including two high school students and one adult.

The 2 youth teammembers must:• Be entering Grades 10-12 in the 2017-2018 academic year,• Be in good standing with the school (attendance, behavior, academics),• Have captured the hearts of peers and/or teachers with a passionfor service to others.

The 1 Adult teammember must:• Work in the students’ school district, and/or• Be a community member within the district’s geographic area, and• Be approved by the students’ school administrator to drive the students toand from Heartland Foundation’s emPowerU® Campus in St. Joseph, MO.

• Students may or may not be the typical honor student with the highest grade pointaverage and long list of extracurricular activity accomplishments. They may bethose that have not had an opportunity to maximize their leadership potentialthrough traditional avenues.

Learning tolisten and lead

“It is an experiencethat is irreplaceable.It makes you feel soimportant andpowerful. I feel Ihave the knowledge tochange the world, orat least make a start.”

—2015 e2 FellowshipYouth Graduate

WHERE:Heartland Foundation’semPowerU® Campus518 S. 6th Street

St. Joseph, MO 64501

© 2017 Heartland Foundation. All rights reserved.1 of 2

FINAL DEADLINE IS: FRIDAY, SEPTEMBER 8, 2017Each teammember is required to complete this form.

Submitting all three team members at the same time is recommended. Acceptance is on a �irst come, �irst served basis.

APPLICANT

Last Name______________________________________ First Name_______________________________________

Name You Prefer to be Called_________________________________________ Date of Birth____/____/_________

Home Mailing Address ____________________________________________________________________________

City______________________________________________________________State_______Zip________________

Primary Email Address_____________________________________________________________________________

Primary Phone ______-______-__________ O.K. to Text? ❍ Yes ❍ No

Any Special Dietary Restriction(s)____________________________________________________________________

❍ Student Team Member Entering Grade ___ Fall 2017

2017-18APPLICATION andAGREEMENT FORM

❍ Adult Team Member

❍ School District_________________________________________________________________ or ❍ Homeschool

Local Newspaper______________________________________________________________________________

TEAM’S SCHOOL ADMINISTRATOR

School Administrator Name_________________________________________________________________________

School Mailing Address ____________________________________________________________________________

City______________________________________________________________State_______Zip________________

Primary Email Address_____________________________________________________________________________

School Phone ______-______-__________ Mobile Phone ______-______-__________ O.K. to Text? ❍ Yes ❍ No

❍ This applicant (student or adult) will not be counted absent by participatingin this experiential learning program outside the school district campus.

STUDENT APPLICANT PARENT/GUARDIAN

Name(s)________________________________________________________________________________________

Primary Email Address_____________________________________________________________________________

Daytime Phone ______-______-__________ Mobile Phone ______-______-__________ O.K. to Text? ❍ Yes ❍ No

Date Form and EssayReceived: _____/_____/_____

Date DepositReceived: _____/_____/_____

TotalAmount Due: $________________

think ahead

518 S. 6th Street | St. Joseph, MO 64501-9820 | p 816.271.7200 | tf 800.447.1083 | f 816.271.7269info@heartlandfoundation.org | facebook.com/HeartlandFoundation | heartlandfoundation.org

APPLICANT ESSAYPlease brie�ly explain what the phrase “education empowers” means to you.

(Please limit narrative to 500 words or less. Entries may be submitted on an additional page.)

PARTICIPANT AGREEMENTI agree to participate in all four sessions of the e2 Fellowship listed to the left.

Sessions start at approximately 9 a.m. and end at 2 p.m.

I understand that the images, videos, and audio recording, in which I am a participant, is being produced and isowned by Heartland Foundation. I hereby acknowledge that my participation may be edited and used in wholeor in part as desired in any way by Heartland Foundation included, but not limited to being reproduced,duplicated, and used for non-theatrical audiovisual informational, public relations, and general educationalpurposes. I also consent to the use of my likeness and voice for all purposes listed above in connection with theimages and audiovisuals through traditional print, radio, television and/or online media platforms.

Applicant’s Signature____________________________________________________________________________________Date____/____/20_______

If under the age of 18 years, this release must also be signed by the participant’s parent or legal guardian.

Parent/Guardian Signature____________________________________________________________________________Date____/____/20_______

Parent/Guardian’s Printed Name_________________________________________________________________

REGISTRATIONProgram Fee: $375 per team covering up to three individuals ($125 per participant)

Application and Payment Deadline is September 1, 2017.

• The team fee includes 4-days of program facilitation, materials, and lunches. It does not cover transportation or lodging.• Applicants are accepted on a �irst come, �irst served basis for up to 12 teams. (If more than 12

teams are committed to participating, a second class for the 2017-2018 academic year may be opened.)

• Applicants may also register online at www.heartlandfoundation.org/what-we-do/programs/e2fellowship/

PAYMENT: ❍Check enclosed payable to Heartland Foundation

❍Credit Card Amount authorized to charge $_______________❍VISA ❍Mastercard ❍Discover ❍American Express _____________________________________________________

Card #________________________________________________________________________________________________________________________Exp. Date Security Code Signature

MAIL TO: EMAIL: jennifer.paolillo@heartlandfoundation.orgFAX: 816-271-7269CALL: 816-271-7859 with any questions.518 S. 6th Street, St. Joseph, MO 64501

Heartland FoundationAttn: Jennifer Paolillo, e2 Fellowship

Thank you for your interest in the e2 Fellowship Program.

09.13.201711.08.201701.10.201803.14.2018

518 S. 6th Street | St. Joseph, MO 64501-9820 | p 816.271.7200 | tf 800.447.1083 | f 816.271.7269info@heartlandfoundation.org | facebook.com/HeartlandFoundation | heartlandfoundation.org

© 2017 Heartland Foundation. All rights reserved.2 of 2

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