Teen Center Application Form
Please fill out the application/interest form.

Remote Learning Program start on Monday, August 17th. Mandatory Orientation Session TBA.

Priority registration for students who do not have access to internet.

If you are interested in other Teen Center Resources or virtual tutoring opportunities only, please email Amanda at amanda@bgccoastside.org for more information.
Student [Full Name]
Student Email Address
Student Phone Number
Parent/Guardian Names
Parent/Guardians Phone Number
Parent/Guardian Email Address
Do you have internet to access remote learning?
Clear selection
Do you have a quite space to study and complete school work at home?
Clear selection
How many class periods are you taking?
Do you have first period class on Monday/Thursday starting at 8 am?
Clear selection
We offer financial assistance for those that need it. Would you be interested in financial assistance?
Clear selection
Please fill in any other reasons why you are interested in the program?
We will need to set up an mandatory orientation session. Please mark the preferred method of orientation you would like to attend:
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