2020 Summer Workshop Series Application
We have  free online workshop series available for Norwalk students from low-moderate income households (Up to $140,000 annually.
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Which program(s) are you applying for? *
Required
Student Info
Student First Name *
Student Last Name *
Gender *
Year in School *
Preferred Student Telephone Number *
Preferred Student Email Address *
Permanent Home Address (Number & Street) *
Permanent Home Address (City,  State) *
Permanent Home Address (Zip Code) *
School (e.g Norwalk High School, UNH) *
Do you have any allergies? *
If yes, please identify:
Do you take any medications regularly? *
If yes, please identify:
Do you have any health concerns (e.g. asthma)?
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If yes, please identify:
Emergency Contact Info
Emergency Contact Name *
Emergency Contact Phone Number *
Family Info
Parent/Guardian 1 Name *
Parent/Guardian 1 Phone Number *
Parent/Guardian 1 Email Address *
Parent/Guardian 2 Name
Parent/Guardian 2 Phone Number
Parent/Guardian 2 Email Address
Annual Household Information
Eligible participants in the College Edge Program must reside in Norwalk households of low to moderate income.  
Number of persons in household, including head of household: *
Please enter gross annual income for all persons living in the household who are over the age of 18 and not in school. *
Agreements
To ensure commitment to the program, new participants must submit a $50 deposit due on the first day of program, which will be refunded after the participant completes the program. *
Media Release:  I authorize HELP, Inc. to photograph me, take video footage of me, and/or make electronic sound recordings of me (herein referred to as photographic or electronic reproductions). I authorize the use of any such photographic or electronic reproductions of me for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by HELP, Inc. (I understand that I may be identifiable from such photographic or electronic reproduction). *
Certification of Information:  I hereby certify that the information on this form is complete and correct to the best of knowledge.  I also hereby authorize the Redevelopment Agency of the City of Norwalk to verify any and all income information provided on this form. *
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