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:
DETAILS
- 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
APPLICATION GUIDELINES
- 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 (
sdriffin@conncat.org
); Stephanie Mallard (
smallard@conncat.org
)
* Required
Child Last Name
*
Your answer
Child First Name
*
Your answer
Address
*
Street, Unit, City, State, Zip
Your answer
Grade
*
GRADE DURING FALL 2020
Choose
6
7
8
9
Age
*
Your answer
School Name
*
Your answer
Date of Birth (Please manually enter the year)
*
MM
/
DD
/
YYYY
Gender
*
Choose
Female
Male
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.
Yes
No
Required
Sibling Name(s)
Your answer
Do you consider your child to be Hispanic or Latino?
Yes
No
Clear selection
Ethinicity/Race
Black or African American
White/Caucasian
American Indian or Alaskan Native
Multi-Racial
Asian/Pacific Islander
ConnCAT Email / Remind App
How did you first hear about the ConnCAT Safe Space Learning Hub?
*
Facebook, Instagram, or other social media
TV Advertisement
School Announcement
Family member/friend
Existing ConnCAT participant
ConnCAT Adult Program Info Session
ConnCAT website
Other:
Required
Parent 1 Last Name
*
Your answer
Parent 1 First Name
*
Your answer
Parent 1 Street Address
*
Street and (Unit #)
Same as child
Other:
City
*
Same as child
Other:
Zip Code
*
Your answer
Parent 1 Cell Phone Number (Example: (203) 111-1111)
*
Your answer
Parent 1 Daytime Phone Number (Example: (203) 111-1111)
*
Your answer
Parent 1 Email Address (please ensure email is correct)
*
Your answer
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.
Choose
Yes
No
Parent 2 Last Name
Your answer
Parent 2 First Name
Your answer
Parent 2 Cellphone Number (Example: (203) 111-1111)
Your answer
Parent 2 Daytime Phone Number (Example: (203) 111-1111)
Your answer
Parent 2 Street Address
Street and (Unit#)
Your answer
City
Your answer
Your answer
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