ConnCAT Safe Space Learning Hub Fall Program-2020 6th-9th grade
Welcome to ConnCAT's newly designed Safe Space Learning Program. This is a 10 week program that will only accommodate 32 STUDENTS. Selection will be based as evenly as possible by grade and gender. Please fill out the application and note the details below:


- Program Start Date: September 8, 2020(Program will follow NHPS)
- Hours: Mon - Fri 8:00 am-3:30 pm (Program hours are also contingent upon NHPS hours)
- Parents must arrange transportation for drop-off/pick-up

- Parents/Guardians must submit 1 application PER CHILD.

- Our program heavily relies on text and email to contact parents. Please provide us with ACTIVE phone numbers and/or email addresses that you check regularly.

- Please click on "SUBMIT" at the very end of the online form to ensure delivery.

*Open enrollment. Parents will be notified via email of their acceptance status no later than September 3, 2020. All other applications will be placed on a Wait-List.

*Realizing the ever-changing current events regarding the COVID-19 virus, ConnCAT reserves the right to adjust program dates and times accordingly if deemed necessary.

Questions? Contact Steve Driffin (; Stephanie Mallard (
Child Last Name *
Child First Name *
Address *
Street, Unit, City, State, Zip
Grade *
Age *
School Name *
Date of Birth (Please manually enter the year) *
Gender *
Does your child have a sibling applying for the ConnCAT Safe Space Learning Hub? *
If your answer is YES, please type their sibling's name(s) in the space provided. A separate application MUST be completed for each child.
Sibling Name(s)
Do you consider your child to be Hispanic or Latino?
Clear selection
How did you first hear about the ConnCAT Safe Space Learning Hub? *
Parent 1 Last Name *
Parent 1 First Name *
Parent 1 Street Address *
Street and (Unit #)
City *
Zip Code *
Parent 1 Cell Phone Number (Example: (203) 111-1111) *
Parent 1 Daytime Phone Number (Example: (203) 111-1111) *
Parent 1 Email Address (please ensure email is correct) *
Would you like to receive text notifications for emergencies/occasional updates? *
Remind 101 is a free text message system and is our primary form of mass communication during the summer program. You will NOT be enrolled automatically, but will need to follow a set of instructions on your phone to be enrolled once your child has been admitted to the program. This is MANDATORY for ALL accepted parents.
Parent 2 Last Name
Parent 2 First Name
Parent 2 Cellphone Number (Example: (203) 111-1111)
Parent 2 Daytime Phone Number (Example: (203) 111-1111)
Parent 2 Street Address
Street and (Unit#)
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