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Freedom School Scholar Enrollment Form
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* Indicates required question
Email
*
Your email
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Child's Middle Name
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Home Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Child's Level
*
Level I (grades K-2)
Level II (grades 3-5)
Child's Gender Identity
*
Female
Male
Non-binary
Decline to state
Other:
Child's Preferred pronoun
*
She
He
They
Other:
Child's Race/Ethnicity (check all that apply)
*
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
Black or African-American
Hispanic/Latino
White
Other:
Required
What is your child's reading proficiency level?
*
Below Grade Level
At Grade Level
Above Grade Level
Please list any languages your child speaks at home
*
Your answer
Is your child an English Language Learner?
(English is not their first language)
*
Yes
No
Type of School that your child attended for the 2023-2024 school year
*
Public
Charter
Private
Home
Other:
Child's School Name
*
Your answer
School City
*
Your answer
School State
*
Your answer
Does your child receive or qualify free/reduced price lunch at school during the academic year?
*
Yes
No
Has your child ever attended a CDF Freedom Schools Summer or After-School program before?
*
Yes
No
If yes, how many years has your child participated in the CDF Freedom Schools Program?
Your answer
Does your child have health insurance?
*
Yes
No
If yes, what is your child's health insurance carrier?
*
Medicaid
Other:
Has your child ever qualified for an Individual Education Plan (IEP) or 504 plan?
*
IEP
504
No
What are some strategies our team can use to best support your child's learning throughout the program? (ex: needs additional reading help, prefers small group)
Your answer
Does your child have any allergies or health conditions of which we should be made aware of? If yes, what?
Your answer
Is there anything else you would like to share about your child?
Your answer
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