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  • 2021-2022

    Innovation Boulevard

    Afterschool Registration 

    Health & Science Innovations

     

  • Innovation Boulevard(iBLVD) is an afterschool program provided by Health and Science Innovations, Inc. and MSDLT at Belzer or Fall Creek Valley Middle Schools.

    To register, parents/guardians must complete this form. If you are registering more than one participant, please submit a separate form per child. The registration has to be filled in one session. 

    Please complete every section of this registration! Spots are available on a first-come-first-served basis.

     

     

     

     

  • Requirements

  •  

    The minimum required attendace for Innovation Boulevard Afterschool is 65 out of 130 days of programming. This allows flexiblibity for participants who need it or who also participate in other concurrent extracurricular activities (sports, clubs, etc.).

     

  • I will commit to at least 65 days of attendance :*

  • Participant's Information:

  • Format: (000) 000-0000.
  • High School Class*
  • Participant will attend Innovation Boulevard Afterschool Program:*
  • About how many days do you plan for the participant to attend?*
  • Does the participant have a specialized Individual Education Plan?*

  • Demographics

    HSI values diversity and equity in STEM fields. To that end, we seek to ensure diversity in our programs. Collecting demographic data from our participants helps us evaluate our success in this objective. Responses will not affect entrance to the program.
  • Gender*

  • Participant's ethnic background is best described as (choose all that apply):*

  • Participant identifies their race as (choose all that apply):*

  • Do you participate in a "Free or Reduced Meal" Program?*

  • Parent / Guardian Information:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Logistics Information:

  • I prefer to receive communications about the program via (select all that apply):*

  • I prefer to receive communications in:

  • Interests and Goals:

    We would like to start getting to know your child and their interests before we start the program. Please fill this out with your child. Their input will also help us better serve them.
  • 0/300
  • Select the three top subjects you are most interested in:*
  • 0/200
  • 0/200

  • Signature Conditions

    By signing below, I attest that all information included in this application is complete and correct. 

  • Reload

  • Health and Science Innovations, Inc.

    2060 N. Shadeland Ave., Suite 110 | Indianapolis, IN 46219

    Ph: (317) 703-7836 | contact@scienceinnovations.org

    www.scienceinnovations.org

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