TCR Student Application Form

Thriving Children Regardless Student Application Form

Monthly Meeting Sessions (M&Ms)
Welcome!!

Please review and answer the questions below. All students are handpicked for our program. You will receive an email within 48 hours on your application status. If the student qualifies for our program the email will give further instructions on the next steps. Thank you & God Bless!
Student Name*

First NameLast Name
Phone Number

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Name of School & Current Grade*
Gender

MaleFemaleN/A
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian Name*

First NameLast Name
Parent or Guardian Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Medical Information
Do you have health insurance? If yes, provide the name of insurance and policy number. If no, write N/A.*
Please state if your child has any allergies, illnesses, or medical conditions.*
Annual Household Income*

$30,000 and under$31,000 - $45,000$46,000 - $60,000$61,000 - $75,000$76,000 and up
Is your child involved in any extra curriculum activities? If so List below. If not write N/A.*
Question for the student... What challenges have you had to overcome or what challenges have you helped others overcome? Please explain in detail.*
Question for the student... Why do you want to THRIVE? & What makes you THRIVE?
I, First Name Last Name the parent or guardian of First Name Last Name give permission for this application to be submitted to Thriving Children Regardless Nonprofit Organization.

Signature Date
How did you hear about our program?
Should be Empty:

Thriving Children Regardless Student Application Form

Welcome!!

Medical Information