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2020 360 Reads Summer Program Application
A 6-week reading intervention program for rising 4th - 6th grade, African-American boys.
July 6 - August 14, 2019, 9:00 am - 11:30 am, Monday through Friday.
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* Indicates required question
Your Name
*
Your answer
Relationship to student(s)
*
Your answer
What is the student's current grade?
*
3rd grade
4th grade
5th grade
Other:
Required
What school does the student attend?
*
Homeschool
Other:
Required
Caregiver Type
*
Parent
Legal Guardian (legal documentation required)
Other:
Required
Caregiver Name
*
Your answer
Caregiver Gender
*
Female
Male
Other:
Required
Caregiver Relationship to Student(s)
*
Your answer
Caregiver Phone
*
Your answer
Caregiver Email
*
Your answer
Caregiver Address
*
Your answer
Is there a second caregiver?
*
Yes
No
Maybe
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