Afterschool Enrichment Application
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Has your student previously been enrolled with us?
Which school does your child attend? *
Please choose the child's 2019-2020 grade level *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Does your child have an IEP (Individual Learning Plan)? *
If yes, please provide documentation via email to info@motivateourminds.org
Does your child have an ELP? *
If yes, please provide documentation via email to info@motivateourminds.org
Does the child receive free or reduced lunch at school? *
If yes, please provide documentation via email to info@motivateourminds.org
Please list any allergies or medical needs.
Your answer
Child's Career Interest Area
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