Which group will your child be joining? (children on the cusp should reach out to cristina@techkidsunlimited.org if you are unsure which would be a better fit. *
Parent/Guardian Name *
Your answer
Parent/Guardian Email Address *
Your answer
Phone Number *
Your answer
Address *
Your answer
Where does your child go to school? *
Your answer
Is your child funded to go to this school?—i.e. Are you approved by CSE, are you suing the DOE, did you get financial aid? Please give us any and all background. *
Your answer
How many children are in your family? *
Your answer
If more than one, where do the other children go to school?
Your answer
Who is employed in the household? Where are they employed? *
Parent 1? Parent 2? Other?
Your answer
If your child goes to public school, do you qualify for the free lunch program? *
Please list services your child is currently receiving as part of their educational or clinical treatment plan. Include expenses related to these services. *
ie. Psychotherapist, Reading Tutor, etc.
Your answer
Parent/Guardian highest level of education *
Your child’s ethnic and racial background is: *
Parent Martial Status *
Please indicate annual household income (as reported on recent tax return) *
What do you believe your child will gain by participating in this program? *
Your answer
Please tell us any other extenuating circumstances you would like us to know.
Your answer
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