Pathways Academy Interest Form 
This form will inform the Pathways Academy team of your interest in the program.
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Email *
Scholar (Child's) Name #1 *
Scholar #1 Grade *
Scholar #1 School Name *
Academy selection for Scholar #1 : Which program will your scholar attend? *
Scholar (Child's) Name #2
Scholar #2 Grade
Scholar #2 School Name
Academy selection for Scholar #2 : Which program will your scholar attend?
Clear selection
Scholar (Child's) Name #3
Scholar #3 Grade
Scholar #3 School Name
Academy selection for scholar #3: Which program will your scholar attend?
Clear selection
Please provide a current phone number. *
Site Area: Pathways Academy Site Location  *
Temporary Assistance for Needy Families (TANF) Eligibility
In this next section, please answer the following questions regarding governmental assistance.

TANF assistance includes:
Medicaid, 
Free/Reduced Lunch, 
Supplemental Nutrition Assistance Program (SNAP), 
Transitional Employment Assistance (TEA), 
Supplemental Security Income, 
Low Income Home Energy Assistance Program (LIHEAP), 
Women, Infants, Children (WIC), 
Housing and Urban Development (HUD), Section 8/Public Housing
Are you TANF eligible? *
Are you receiving TANF? *
¿Prefieres recibir información en español? Do you prefer to receive information in Spanish? *
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