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Dream Center Evansville
Program Interest Application
Please note the qualifications to be eligible for programming at the Dream Center:
*Primary residence must be in Jacobsville.
*If school aged, students attend Delaware, North Jr, or North High School unless attending a different school due to an IEP.
*Parent is willing to sign an EVSC release of information waiver.
*Parent is willing engage in a "Promise Partnership" with Dream Center to promote the overall success and flourishing of your student.
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Parent/Guardian First Name *
Parent/Guardian Last Name *
Phone Number *
Street Address, Zip *
Number of children under the age of 18 in your household:  *
Please Select All Grade Levels of Your Children *
Required
Schools in which your students are in attendance:  (check all that apply) *
Please list your children's names *
Which programs are you interested in for your students? (check all that apply) *
Required
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