Student Enrollment Form
Today’s Date:
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/
DD
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Student Name: (Print full Name) *
Student Address
City/St
Zip Code
Phone *
Email *
Grade
School
Date of Birth
MM
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DD
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Age
Gender
Have you been a member of Goal Card in the past?
What school did you attend during the last school year ?
Are you currently involved in any after school program? (for example: Boys & Girls Club, Emmanuel Center, Knowledge Quest, STREETS, etc.)
If Yes, to after school program please list below:
Is your family currently involved in one of the Rise Foundation Programs? ( Neighboring Silvers, Save Up, etc.)
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