STARTALK Registration 2018
Dear Parents/Guardians,

Please complete the questions below. All STARTALK registrations are done online this year. If you completed a form from the summer school catalog, please make sure to complete this form as well.

Registration is on a first-come, first served basis. We hope to be able to accommodate all students. We will send you a confirmation email within a few weeks. As a part of our grant, we will include with the confirmation email some forms that will need to be returned to us before the program begins.

Thank you.
Student Last Name *
Your answer
Student First Name *
Your answer
APS Student ID# (Please write "01" if you are a Non-APS student) *
Your answer
School 2017-2018: *
Your answer
Grade 2017-2018: *
Your answer
Is your child on an IEP?: *
If your child is on an IEP, who is the case manager?
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Home Language *
Your answer
Is student English proficient? *
Address *
Your answer
Parent/Guardian: *
Your answer
Parent/Guardian email address *
Your answer
Parent/Guardian Phone *
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
Medications/Medical Problems *
Your answer
Preferred Course *
Transportation to Kenmore Middle School: My child will: *
My child will be able to be present all 15 days of the program, from July 9-27: *
Email will be our main mode of communication. Please indicate below if you would prefer otherwise.
Parent/Guardian Name, to serve as signature *
Your answer
Date, to serve as signature *
MM
/
DD
/
YYYY
Submit
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