This form should be completed by a parent, guardian, or other person over the age of 18 representing the student. By submitting this form, the parent/guardian agrees to the information release detailed on the Citywide Classroom website: citywideclassroom.org/information-release.

If you have multiple students in your household, you only need to fill this application out for one student.

Note that this form cannot be saved and returned to. For questions about the application form or process, contact Citywide Classroom at info@citywideclassroom.org or by calling (574) 703-1881.