G.A.U.G.E. Program Application

Welcome to The G.A.U.G.E. (Grow As U Go Enrichment Program)! This Enrichment Program is a parent referral program, that provides a unique opportunity for young people to gain conflict resolution & emotional intelligence tools and valuable skills, knowledge, and experience that will benefit them both in the short and long term. The next cohort will begin Monday, January 8, 2024 - May 24, 2024, and space is limited! We only accept 20 students per cohort.

Program Times: 5:00pm - 8:00pm (6th grade - 12th grade) unless previously discussed with Director

Location: 112 Lexington Ave (The Lower Level) Elkhart, IN 46516.

By completing this application, one student per form, I agree to apply for a scholarship to cover the Program Fee per child/week. The fee includes meals, materials and field trips. I agree or consent to the Rules & Regulations of the G.A.U.G.E. Program and agree to support the mission to Empower the Southside Youth Together!

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Today's Date *
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Name *
Student's First and Last Name
School Name: *
What session are you registering for: *
Student Grade Level: *
Student's Birthdate *
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Parent Email *
Phone number *
Home Address *
Student's Gender: *
Language Spoken *
What Clubs are your child interested in : (Check all that apply) *
Required
Emergency Contact and Phone Number *
Authorized Pick up person (Other than Guardian) *
Number of children you have at home: *
Primary Employment *
Annual Income: *
Guardian's Highest Education Level: *
Scholarship Needed: *
Does your Child have Any Known Allergies *
Required
Does your Child have any Dietary Preferences? *
Required
Would you be interested in? *
Required
Preferred Method of Communication *
Within 48hrs, you will be contacted by our Intake Coordinator to schedule your consultation. During your consultation, we will review the program details, out-of-pocket cost, scholarship information and complete the application process, please allow 45mins-1hr. 

If you have any questions or you are not contacted within 48hrs, please email Leatra Scott at lelscott@outlook.com. Thank you and we will see you soon! Select YES if you have read and understand this information:
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