Student Enrollment Application
Eligibility Requirements & Code of Conduct:
Both Student and Parent/Legal Guardian needs to read and sign below.
SCEC is a private entity that serves students without regard to race, color, sex, age, residency, national or ethnic origin, religion, sexual orientation, ancestry, or any other protected status. To qualify for programs and events at SCEC, students must meet the criteria listed below. Otherwise qualified persons are not subject to discrimination. Be in 6th-12th grade (begin summer entering 6th grade through summer after HS graduation) AND be at least 12, but less than 19 years of age. Adhere to the code of conduct and respect staff and volunteers at all times. Be able to function independently during programs and events AND communicate effectively with adults and other students. Not require SCEC to make fundamental alterations to and/or disrupt the harmony of programs and events. Not undermine the safety of staff, volunteers, students, or themselves.
SCEC reserves the right to deny service at any time based on any of the aforementioned eligibility requirements, or for any other reason, including the actions of the student, parent, or guardian. These eligibility requirements are subject to change without notice, and are permanently posted on our website for review at any time. At SCEC, we maintain a safe and fun atmosphere for students based on the following Code of Conduct:
Abusive language towards a staff member, volunteer or another
Possession or use of alcoholic beverages
or illegal drugs on SCEC property or reporting to the
program while under the influence of drugs or alcohol.
Bringing onto SCEC property dangerous or unauthorized
materials such as explosives, firearms, weapons or other similar items.
Discourtesy or rudeness to a fellow participant, staff member or
Verbal, physical or visual harassment of another participant, staff
member or volunteer.
Actual or threatened violence toward any individual or group.
Conduct endangering the life, safety, health or well-being of others.
Failure to follow any agency policy or procedure.
Bullying or taking unfair advantage of any participant.
Failing to cooperate with an adult
If students are unable to adhere to the Code of Conduct and have repeated or extreme infractions, SCEC reserves the right to contact student's guardian/parent(s) and/or the authorities.
SCEC reserves the right to suspend enrollment privileges, require community service to regain membership privileges, or terminate membership at the discretion of the SCEC staff.
Name (Last, First, Middle)
Prefer not to say
Date Of Birth
Parent/Guardian Information (Name, Phone Number, Home address & best way to contact parent)
PERMISSION TO RELEASE SCHOOL GRADES I authorize South Carolina Empowerment Centre permission to obtain copies of my child's grades and other educational materials to assist SCEC to provide my child with adequate tutoring assistance, pre-college information and job training skills.
TYPED SIGNATURE OF UNDERSTANDING STATEMENT ABOVE.
DOES THE APPLICANT HAVE AN IEP (INDIVIDUALIZED EDUCATION PROGRAM) AT SCHOOL?
DROP OFF AND PICK UP TIMES FOR AFTERSCHOOL ACADEMY DURING SCHOOL YEAR. Drop off time: Immediately following school dismissal (not in session on school holidays) Pick up time: Between 6:00-6:15 PM (Please be respectful of our volunteer's time and be on time)
By checking this box I understand that the pick up time is between 6:00 -6:15 PM.
HOW DID YOU HEAR ABOUT US?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service