ARIN IU 28 and Evergreen 21st Century Program at Leechburg Area S.D. -          Summer 2026 Application 

The summer program is open to students in grades K–5, including those completing Kindergarten and 5th grade this year, but does not accept students who will be entering Kindergarten in the fall.

The program offers STEM activities, field trips, snacks, and fun opportunities. It runs Monday through Thursday, from June 8th through July 16th, from 8:30 a.m. to 2:30 p.m.  No transportation will be provided - all parent pick up/drop off.

Once this form is completed, you will receive a confirmation at the parent email provided within one week of submission.
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Child's Last Name *
Child's First Name *
Student's Date of Birth
 *
MM
/
DD
/
YYYY
Grade Level for the 26-27 School Year *
Race *
Gender *
Child's Physical Street Address
*Ex. 10775 Route 56 Hwy East
 *
PO Box:
If none, please skip this question
City/Municipality
 *
Zip Code
 *
Parent/Guardian 1: Full Name
 *
Parent/Guardian 1: Relationship *
Parent/Guardian 1: Phone #
Example 111-111-1111
 *
Parent/Guardian 1:  Email Address
 *
Parent/Guardian 1: Street Address
If different than above.  If not, please skip this question
Parent/Guardian 2: Full Name
If no 2nd Parent/Guardian, please skip this and related questions.
Parent/Guardian 2: Relationship
Parent/Guardian 2: Phone #
Example 111-111-1111
Parent/Guardian 2:  Email Address
Parent/Guardian 2: Street Address
If different from above.  If not, please skip this question.
Household Members

Please place a checkmark next to all household members who live with the child in the primary residence.  (The total is used for grant reporting purposes and is not identified with your household specifically.)
 *
Required
If more than one sibling (brothers/sisters), please indicate how many total siblings.
Is the child's primary residence a single-parent household?
 *
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