2024-2025 Pagosa Community Initiative's After School Program Application: Middle School
This application does NOT guarantee a spot in Pagosa Community Initiative's after-school programming. Decisions will be made using a weighted lottery system. Notifications of acceptance status will be sent out the week of August 26th.

As recipients of the 21st Century Grant, PCI is excited to announce that our after-school program is now free of charge for all participants.

Please fill out a separate application for each student. 
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Primary Guardian’s Name (First & Last) *
Primary Guardian’s Phone Number *
Primary Guardian’s Email *
Preferred Method of Contact *
Relationship to Student *
Student Name (First & Last) *
What school does your student attend? *
Student’s Date of Birth *
Grade level for the 24/25 school year: *
What days of the week do you need after school care? *
Required
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