Girls Inc. Afterschool Program
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Program Details
Program Starts November 12th, 2020
Thursdays & Fridays 3:30PM - 4:30PM
Girls Inc. of Carpinteria is providing a virtual programming experience through which Girls Inc. staff will facilitate program activities through an online platform. Girls Inc. of Carpinteria will use an application provided by the Santa Paula Unified School District called Google Classroom. Please refer to your digital use requirements provided by SPUSD. Reach out to me with any questions at
yvelasco@spunifiedsd.org
I give permission for my daughter/s to participate in online (virtual) programming in partnership with Girls Inc. and SPUSD.
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Child Name
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Child's Date of Birth
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Child's School
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Child's Grade as of August 2020
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6th
7th
8th
Girls Inc. of Carpinteria Census Report 2020-2021
This information is kept anonymously and in confidence. It will be used strictly for statistical data reports to the Girls Inc. National.
Number in Household (adults and children):
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Child's Ethnicity
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Asian American
Black/ African American
Filipina
Hispanic/ Latina
Pacific Islander
Native American
White/ Caucasian
Multiethnic
Other
Primary Language
English
Spanish
Farsi
Tagolog
Mandarin
Vietnamese
Other:
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Family Configuration
Living with two parents
Living with mother only
Living with father only
Living with one parent at a time (joint custody)
Neither Parent (grandparent, foster or relative)
Multi-Family
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Income Category
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Below $10,000
$10,000- $20,000
$20,000- $30,000
$30,000- $40,000
$40,000- $50,000
$50,000- $60,000
Over $60,000
Child Qualifies for
Free Lunch
Reduced Lunch
Other:
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Please select the highest of education
Less than high school
High School diploma / GED
Some college
2 year college
Bachlelor's Degree
Master's Degree
Doctoral Degree
Professional Degree
Don't Know or N/A
Mother
Father
Less than high school
High School diploma / GED
Some college
2 year college
Bachlelor's Degree
Master's Degree
Doctoral Degree
Professional Degree
Don't Know or N/A
Mother
Father
Clear selection
Is any member of immediate family active duty military personnel?
Yes
No
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Is your child an English Learner?
Yes
No
Clear selection
Does your child have an IEP?
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No
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Contact Information
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Parent / Guardian Name
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Your answer
Parent / Guardian Phone Number
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Parent / Guardian Email Address
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Student's Santa Paula Unified School District Email (Meeting invites/updates will be sent to this email)
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Home Address
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