Don Benito LEARNs After School Program Application

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Please note: You will receive a program packet from the LEARNs Site Coordinator at your child's school that includes required enrollment documents. All documents must be completed and returned to the LEARNs Site Coordinator at your child's school to complete program enrollment, which is required for program participation.

Student Information

Student Name (First, Middle Initial, Last) *

Gender *

Male

Female

Prefer not to say

Date of Birth *

YYYY

Grade in Fall 2020 *

Student ID#

Race/Ethnicity *

Decline to State

Asian

Hispanic or Latino

Black or African American

White

Middle Eastern

Multiracial

Native Hawaiian or Pacific

American Indian or Native American

Other:

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