• New Member Interest Form

    Thank you for your interest in C4K! We work with residents of the City of Charlottesville or Albemarle County, Virginia who are in 6th-12th grade and are from households with income less than 80% of the region's Median Family Income. Please fill out the information below and we will follow up to answer questions, confirm interest / eligibility, and provide application details.

  • Update 9/15/2026:   Recruitment for the Fall 26 1:1 cohort is now closed.  Please fill out this form if you're interested in joining for the Spring 27 cohort that starts in mid-Jaunuary.

  • Member Information

  • Contact Information

  • Format: (000) 000-0000.
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