Rockland TIPS Interest Form Fall 2020 - Spring 2021
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Full Legal Name *
What name would like us to call you?
What Pronouns do you use? *
What is your Date of Birth? *
MM
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DD
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YYYY
Phone Number *
Email Address *
What is the best way to contact you? Check all that apply: *
Required
Name of School *
Current Grade as of Fall 2020 *
Do you have access to technology at home? (Select all that apply) *
Required
What day(s) of the week can you attend an after school program?
Before we interview you, what are some important things you'd like us to know about you?For example, do you have hobbies, interests, or passions that make you who you are? *
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