Sierra Madre ES LEARNs After School Program Application (Program dates April 13

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Sierra Madre ES LEARNs After School Program Application (Program dates April 13 - June 3, 2021)

$75 non-refundable registration fee due upon acceptance. (Check or money order made payable to PUSD. No cash accepted.) Program is no cost through June 3, 2021.

Student Information

Student Name (First, Middle Initial, Last) *

Gender *

Male

Female

Prefer not to say

Date of Birth *

年

月

日

Race/Ethnicity *

Decline to State

Asian

Hispanic or Latino

Black or African American

White

Middle Eastern

Multiracial

Native Hawaiian or Pacific

American Indian or Native American

其他:

Grade in Fall 2020 *

Student ID#

Does your child's school have cohorts? *

Yes

Unknown

If yes, what cohort is your child in?

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