Student Interest Form




Student Details






If you are on summer break, please indicate your upcoming grade level in the fall.


##.# or #.## (ex. 95.5 or 3.95)

Our communications tools allow us to send messages through SMS with program updates and invitations.  If the student does not have a mobile phone, please enter the primary caregiver's mobile number.


Our communications tools allow us to send messages through email with program updates and invitations.  If the student does not have an email address, please enter the primary caregiver's email address.







Additional Information

Additional State grants may be able to be coordinated for children who have been in a state foster care program.


Primary Caregiver Contact Details





Third Party Contact Details (please enter your social worker's information if you have one)