After-School Live CLUBS: Student Interest Form (Winter 2019)
Thank you for your interest in After-School Live Clubs! Session details:

- Starts January 28 / ends March 1
- Led by middle school students; chaperoned by adult volunteers
- Each club meets once a week, from 3:15-4:15
- Clubs will be filled through a lottery to ensure that each student who is interested has an equitable opportunity to participate. The lottery will be held Tuesday, January 22 at 9:00am in F106.

Please complete all sections of this form by Tuesday, January 22 at 8:00am. Applications received after this deadline will be placed on the bottom of the waitlist. If you have multiple students who would like to participate in a club, please complete a separate application for each student. Only one application per student will be accepted.

If you have any questions, contact Allison Chavez, After-School Programs Coordinator, at

Student last name *
Your answer
Student first name *
Your answer
Parent name (first and last) *
Your answer
Parent email *
Your answer
Student's grade level *
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