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2023 Application for St. Thomas Aquinas College Summer LITERACY and SPECIAL ED Program
TO BE COMPLETED BY PARENT/GUARDIAN
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Parents' Names
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Home Phone Number
*
Please use the FOLLOWING FORMAT: 845-234-1234 or enter NONE
Your answer
Cell Phone Number
*
Please use the FOLLOWING FORMAT: 845-234-1234
Your answer
Email Address
*
Your answer
Child's School
*
Your answer
Current Grade
*
Your answer
Current Teacher(s)
*
Your answer
Reason for applying
*
Your answer
Is your child receiving any services that you would like us to know about? (special education, 504 accommodations, bilingual education, ESL)
Your answer
Does he/she have any allergies or any other health conditions (e.g. asthma, restrictions on activities) relevant to participation in the program?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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