Hilltop Scholars Middle School Interest Form
The Hilltop Scholars Middle School program is only available for 6th-8th grade students attending Jason Lee Middle School. Please complete one form per child.
Summer Academy 2018
Summer Academy takes place Monday-Thursday 8:00 AM to 3:00 PM. The program is located at Jason Lee Middle School and students must be entering grades 6-8 and attend Jason Lee Middle School.
I'm interested in my child attending Summer Academy 2018 *
School Year Program (Sept 2017-June 2018)
The Hilltop Scholars Middle School after-school program takes place Monday-Thursday. The after-school program runs from 3:00 PM - 5:00 PM at Jason Lee Middle School. Students must attend Jason Lee. Students also take part in 1:1 Academic Coaching to get individualized support to be successful in school.
I'm interested in my child attending the School Year Program *
Please tell us more about your student and your family!
Your student's first and last legal name *
Your answer
Student's address *
Your answer
Your student's grade for the 2017-2018 school year *
Your student's race *
Your answer
Is your student on free or reduced lunch? *
Please tell us your student's current school *
Your answer
Parent/Guardian first and last name *
Your answer
Relationship to student *
Your answer
Primary phone number *
Your answer
Email address
Your answer
Alternate phone number
Your answer
Will your student be in the first generation of your family to go to college?
Has your student attended programs with Peace Community Center in the past?
Do you have other children that are in Peace Community Center programs?
If yes, please tell us their names and grade level
Your answer
Why does your child want to be part of this program? Why do you want them to participate?
Your answer
Do you have any other commitments that we should be aware of (sports, youth group, etc)? What is the timing of those commitments?
Your answer
Thank you for your interest in Hilltop Scholars Middle School!
Program staff will follow up with you about that status of your child's participation in Hilltop Scholars. If you have any questions about Hilltop Scholars or this form, please call our Program Director, Keith Blocker at (253) 571-7680.
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