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REACH.U Application 2020-21
REACH.U will be 100% online for Fall 2020, using Google Classroom and Google Meets.
Please fill out entire form for each child enrolling in the program.
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to save your progress.
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* Indicates required question
Email
*
Your email
Child's Name: Last, First
*
Your answer
Parent/Caregiver Email Address (NOT student email)
*
Your answer
School Attending:
*
BMS
KMS
PMS
Homeschool
Grade Level:
*
5th
6th
7th
8th
Parent/Guardian Name(s)
*
Your answer
Preferred Contact Phone Number #1
*
Your answer
Preferred Contact Phone Number #2
*
Your answer
Preferred Contact Phone Number #3
*
Your answer
Mailing Address
*
Your answer
Emergency Contact #1 : Name and Phone Number
*
Your answer
Emergency Contact #2: Name and Phone Number
*
Your answer
Student Birth Date
*
MM
/
DD
/
YYYY
Can this child have a photographed published?
*
Yes
No
We have easy access to reliable internet
*
Agree
Disagree
Grant Required Questions
REACH.U uses the following information for the sole purpose of grants and fundraising. All information will remain confidential and anonymous.
Student Ethnicity
*
White/Caucasian
American Indian
Asian
Black/African American
Hispanic
Two or More Races
Prefer not to answer
Gender
*
Female
Male
Prefer not to say
Is the student eligible for free and reduced lunch at school?
*
Yes
No
Prefer not to say
Does the student have an IEP or 504 plan?
*
Yes
No
Prefer not to say
Please select the type of household the student resides in the majority of the time:
*
ONE biological parent in the home
BOTH biological parents in the home
Grandparents/Kinship Care
Foster Child
Prefer not to say
Other:
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