H.O.P.E Extended Learning Program 2023-2024 Interest Form
Home of Potential and Excellence (H.O.P.E) provides a safe nurturing environment and creative extended learning opportunities through fun academic, physical, and social engagement. Space is limited and services are on a first-come-first-served basis. Please complete the following form and allow us to become an avenue of HOPE for you and your family. Thank you!
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Email *
Preferred Language *
Child's Full Name/Nombre completo del niño: *
Are you a returning H.O.P.E family?/¿Es una H.O.P.E familia que regresa? *
Returning H.O.P.E family, is there any info that needs to be updated?/Familias de H.O.P.E que regresan, ¿hay alguna información que deba actualizarse? *
Date of Birth (month, day, year)/Fecha de nacimiento (mes, día, año) *
Grade Level/Grado del estudiante *
Child's Shirt Size/ Talla de playera *
Name of Parents:/ Nombre de los padres: *
Parent’s Phone Number:/ Numero de telefono de los padres *
Street Address:/Dirección *
Street Address:
Address:/Dirección
Address Line 2:
City/ Ciudad *
State / Province / Region / Estado *
Postal / Zip Code/ Codigo postal *
Services you are looking for?/Servicios que busca? *
Required
Preferred Start Date/Fecha de inicio preferida *
MM
/
DD
/
YYYY
Do you have a DHS Childcare Certificate?/¿Tiene un certificado de cuidado infantil del DHS? *
If Yes, which type?/Si es así, ¿de qué tipo?
Clear selection
Does your child have an Individual Education Plan (IEP)?/ ¿Tiene su hijo un Plan de educación individual (IEP)? *
How did you hear about us?/ ¿Cómo se entero de nosotros? *
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