21st Century Community Learning Centers Electronic Enrollment Form 
This form is only to be used for students enrolled into the 21st CCLC program.  This form is only valid for 2026-2027 school year.
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Instructions
This enrollment form is only submitted once the submission button is pressed at the end of the form. There are 6 sections: Applicant and Parent/Guardian Information, Dismissal and Pick-Up Information, Consent for Photograph/Video Release, Health Information, Student Demographic Information (Optional section), and Evaluation Information and Opt-Out.  Your school's Community School Director will contact you to confirm receipt and submission, and ensure student participation release. 
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