Agents of Change interest form
Welcome to Peaslee's Agents of Change program! Please complete this form to indicate your interest in participating, and we will contact you if there is space in the program. If at any time your contact information changes, please call 513-621-5514 to let us know or resubmit the form.
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Email *
Agents of Change is for students ages 11-15. Agents meet Wednesday afternoons, 4:00-6:00 pm when Cincinnati Public Schools are in session, and Tuesdays-Thursdays in June and July, 9:00am-4:00pm. For any questions about the program, please contact Rachel Hollins, program coordinator, at 513-621-5514 or rachel.hollins@peasleecenter.org.
Parent name *
Phone number *
Residential address *
Are you interested in registering your student for the current school year program, for the summer program, or both? *
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