Middle School Youth Applicant Information - WAITING LIST
***PLEASE NOTE THAT WE ARE AT CAPACITY FOR SUMMER 2020. COMPLETING THIS APPLICATION WILL PUT YOU ON OUR WAITLIST. SHOULD SPOTS OPEN UP WE WILL CONTACT YOU***

Please complete the below information about your student who is applying to be in our Summer Program. There is a $30 fee to apply, which will be accepted the first day of program.
Sign in to Google to save your progress. Learn more
Applicant Youth Name *
Youth Date of Birth *
MM
/
DD
/
YYYY
Current Age: *
Grade (Spring 2020): *
School (Fall 2020) *
Grade (Fall 2020): *
Student H.O. # (SFUSD Students Only)
With what gender does the applicant identify? *
Race/Ethnicity: *
Please select your child's t-shirt size *
Please select your child's preferred enrichment *
Please select your child's preferred sport *
Does the applicant have an Individualized Education Plan (IEP) or 504 Plan? *
Has the applicant ever been held back a grade? *
Has the applicant ever been expelled from school? *
Has the applicant ever been suspended from school? *
Is the applicant currently receiving any mental health support or services? *
Has the applicant been diagnosed with a cognitive impairment? *
Allergies (Please Specify): *
Seizures: *
Other medical conditions: *
Required medication(s): *
How would you rate the applicant's reading performance? *
How would you rate the applicant's math performance? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Opportunity Impact. Report Abuse
Google Forms