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Rogers HS SMILE Membership Form 2022-23
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* Indicates required question
Email
*
Your email
DISTRICT
*
Choose
CENTRAL FALLS
NEWPORT
PROVIDENCE
S. KINGSTOWN
WESTERLY
WEST WARWICK
WOONSOCKET
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender Identity
*
Female
Male
Non-Binary
Other
Student Ethnicity (Check all that apply)
*
Black
White
Native American
Asian
Hispanic/Latinx
Other
Required
GRADE IN SCHOOL FOR 2022-23
*
Choose
4
5
6
7
8
9
10
11
12
CURRENT STREET ADDRESS
*
Your answer
CITY
*
Your answer
STATE
*
Your answer
ZIP CODE
*
Your answer
Have you been in SMILE before?
*
Yes
No
If yes to previous question, which grades?
*
4
5
6
7
8
9
10
11
Required
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