New Member Interest Form

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 9/19/25: Recruitment for the Spring 26 1:1 cohort is now open! Please fill out this form if you're interested and would like to be contacted. If you're ready to sign-up, you can go right to the Member Application
Member Information
Potential Member Full Name*
Grade*
Upcoming grade if we're in the Summer
What school do they go to?*
Upcoming school if we're in the Summer.
If other, please provide school.

Member Information