Kaiser Permanente Thrive Academy Summer Program Application (HS)

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Application for High School. Application contingent on recommendations and participation from 6/20/2023 - 7/14/2023 (excluding July 4).

Thrive is a summer Community Health Program in partnership with Kaiser Permanente. Students learn about social indicators of health and brainstorm solutions to improve health outcomes in the community.

Email *

Student Last Name *

Student First Name *

Student Address (for mailing checks, tshirts, etc.), City, Zip Code *

Student Cell Phone # *

Student Current Grade Level *

Other:

Advisory Teacher (Homeroom Teacher) *

What is your current grade in your Medical Pathway class?

N/A

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Did you participate in the Summer Bridge Program?

Yes

Other:

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Parent/Guardian's Name (Last name, First name) *

Parent/Guardian's Cell/Home # *

Parent/Guardian's email address *

Name of Teacher Recommender #1 *

Email of Teacher Recommender #1 *

Name of Teacher Recommender #2 *

Email of Teacher Recommender #2 *

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