FALL 2019 session: TENTATIVE DATES: Wednesdays + Saturdays /OCTOBER 22-DECEMBER 21


Section 1: Student Information
Student Name *
Student Name
Student Home Address *
Student Home Address
Phone *
Section 2: Student Questionnaire
Do you qualify for free or reduced school fees? *
Section 3: References
Each student must have two recommendations: - One recommendation must be a teacher, counselor, coach, sponsor, or administrator from your school who would complete a recommendation form sent by email. - The second recommendation may also be a person from school or may be be another adult who you have had contact with in a formal setting (i.e. boss, program…). - Please tell them to expect an inquiry by email.
Reference #1: Name *
Reference #1: Name
Reference #2: Name *
Reference #2: Name
Section 4: Parent or Legal Guardian Information
Parent or Legal Guardian Name *
Parent or Legal Guardian Name
Phone *