Please fill this form out for each of your children you would like to register:
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Student Name *
Gender *
How if your student attenting school this Fall?
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Current Grade *
School *
Please mark all of the areas your student could use help in: *
Required
Address: *
Parent/Guardian Name: *
Email: *
Phone number: *
Emergency Contact Phone Number
Emergency Contact
Tutoring locations/locations: (Please select all tutoring options that apply) *
Required
Will your child attend GIAC after school program?
For virtual tutoring, what is your child's availability for tutoring (days of the week, times)?
Do you receive Free/Reduced lunch program? (for grant purposes only) *
Does your child have an IEP or 504 plan?
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Ethnicity (for grant purposes only) *
Required
Have you participated in this program before? *
Where do you live? *
Required
Is there anything you'd like us to know about your student? What do you hope your student will get from their Village academic support?
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