Vendor Registration – Access Village

Imagine being the key holder to unlock a world of possibilities for our Scholars at KEYS Empowers! We’re stoked to team up with community leaders, experts, and cool adults eager to share their treasures of skills and talents. Your wisdom won’t just be shared; it’ll ignite sparks of inspiration in our youth to dream big and go for gold. Together, we’re crafting pathways to new networks, opportunities, and experiences that will sprinkle magic into the lives of our Scholars.

By rocking this form, you’re stepping into the spotlight as a guest mentor in our “Game of Life” after-school program and pledging to:

✨ Shine like a star, sharing your vibes in a way that clicks with our young crew
💯 Keep it real, with honest and engaging responses to comments and questions
🤝 Stick to your word and follow up on promises for our young audience
🎯 Keep the focus on learning and fun; no sneaky ads, agendas, or politics here!
🎉 Dive in, have a blast, and create lasting sparkles with our Heartbeats!

📅 Upon completing the registration form, someone from our team will reach out to confirm your scheduled 30-min time block, 9:30 am-1:30 pm on Monday-Thursday, starting Monday, July 14th, 2025.

You are welcome to do as many sessions as you like (1 per day). A Background Check is required for those who plan to host two or more sessions.

💻

Location: Virtual

(Room directions will be provided before your session)

We look forward to working with you and having you as our guest to share your knowledge and expertise. If you have any questions, please do not hesitate to reach out. Upon review of your request, you will receive an email detailing the next steps.

Thank you for your partnership.

Questions, comments, or concerns email: adoswell@keysempowers.org

Email:(Required)

Phone:(Required)

What is your Instagram Handle?

If none or inactive, type N/A

What is your Facebook name?

If none or inactive, type N/A

What is your LinkedIn profile?

If none or inactive, type N/A

What is your website address?

If none or inactive, type N/A

What is your LinkedIn profile?

If none or inactive, type N/A

Who were you referred by?

Name or Organization

What is your current profession?

What subject matter would you like to present on during your Game of Life session(s)?

Please complete this sentence about your session. Youth will learn or be exposed to…

Please describe the theme of your session using ONE WORD:

Will you be sharing any visuals?

Visuals are optional.

If you plan to share any visuals please be sure they are as FUN, informative & interesting as possible.

Max. file size: 768 MB.

Photo Media Consent:(Required)

If I choose to consent and authorize KEYS to take photographs or motion pictures of myself (and/or my organization/company’s engagement(s)); or to produce videotapes, audiotapes, closed-circuit television programs, webcasts, or other types of media productions that capture myself (and/or my organization/company’s engagement(s)), voice, and/or image (any of the foregoing types of media are called the “Materials” in this Consent and Release form). I authorize KEYS to copyright the materials, and I authorize KEYS to use, reuse, copy, publish, display, exhibit, reproduce, license to a third party, and distribute the materials in any educational or promotional materials or other forms of media, which may include, but are not limited to university publications, catalogs, articles, magazines, recruiting brochures, websites or publications, electronic or otherwise, without notifying me. I agree with these items to be used up to 99 years after the initial date of use. I agree that I am participating on a voluntary basis and I will not receive any payment from KEYS for signing this release or as a result of any publication of the materials.

Please upload a professional headshot to be used on your Game of Life promo flyer. Please label the photo with your first name and last name.(Required)

Max. file size: 768 MB.

📅 Participation Dates

What days do you want to be our guest? (check all that apply, you can do more than 1 session)

Date Time Picker

Select Day	Select Week	Select Time	Actions

There are no Time Slots.

How did you hear about this opportunity?

Consent for Participation in Program Review

We are conducting a review of our program to better understand the experiences of our scholars. Your feedback is invaluable in helping us enhance the quality of our offerings and support for our scholars.

About This Review

As a part of this review, we would like to collect audio, video, and/or written responses regarding your experiences within the program. This will involve sharing your thoughts, feelings, and insights related to your engagement and any other relevant aspects of the program.

Important: Your participation in this review is entirely voluntary, and you may choose not to answer specific questions if you prefer. However, we kindly ask that you agree to the following conditions in order to participate:

1. Data Collection

By consenting to participate, you authorize us to collect audio, video, and written materials related to your program experiences. These materials will be used solely for the purpose of program improvement and to share insights with relevant stakeholders.

2. Confidentiality

Your responses will be kept confidential. Any identifying information will be removed or anonymized before analysis and reporting to ensure your privacy is protected.

3. Right to Withdraw

You may withdraw your consent and discontinue your participation at any time without any consequences. If you decide to withdraw, any data collected up to that point will be destroyed unless otherwise specified.

4. Use of Responses

By consenting to this review, you agree that your responses may be used in aggregate reports, presentations, or publications. Your individual identity will remain confidential.

(Required) By signing below, I indicate that I have read and understood the purpose and conditions of this review and have chosen my my level of participation.

Today's Date:

I consent to all terms

GAME OF LIFE VENDOR REGISTRATION

Location: Virtual

📅 Participation Dates

Consent for Participation in Program Review

Consent for Participation in Program Review

About This Review

1. Data Collection

2. Confidentiality

3. Right to Withdraw

4. Use of Responses