2025-2026 P.A.R.K. Student Nomination Form

2025-2026 NOMINATION FORM

This form will nominate students for entry into P.A.R.K.'s 2025 probationary summer program, and subsequently, 2025-2026 school year program.
Please take a moment to consider the student you have selected for membership in our program. It is very important that you give an accurate assessment of the student’s skills and abilities. It will help in determining the student’s chances for success in P.A.R.K.
Name of Student*
Date of Birth *
Example: 05/16/03
Gender:*

MaleFemale
Race
Ethnicity
Student's T Shirt Size
Grade*

7th8th
Current School Learning Choice*

On-Site Schooling
Please select your child's current middle school from our list of partner schools below:*
Current GPA (based on most recent report card)
(Please attach a copy of the most recent report card to this form.)
Upload Report Card Only Here - NO Interim reports will be accepted

Cancelof
Parent/Guardian(s) Name:*

First NameLast Name
Relationship to student*
Contact Phone Number*
Enter a valid phone number with area code.
Would you like to receive text communication?

YesNo
Email Address
example@example.com
Would you like to receive email communication?

YesNo
Mailing Address*

Street Address

Street Address Line 2/Apartment Number

CityState / Province

Postal / Zip Code
How did you hear P.A.R.K.'s recruitment?*
If you selected "Other" for the previous question, please explain how you first heard about P.A.R.K.
Nominating Counselor/Teacher/Staff (If Applicable)

First NameLast Name
Please state why you feel this student needs P.A.R.K.*
Guardian's Signature*

Clear
To access student's report cards
By signing this form you give PARK permission to access your child's report cards.
Date
Please Note: This application is not complete and cannot be reviewed for selection until a first or second nine weeks report card is submitted to P.A.R.K.

We can NOT accept Interim reports for eligibility into the program
For further questions or comments, you may contact P.A.R.K. at:

● 6915 Geyer Springs Rd, Little Rock, AR 72209

● Email: park@positivekids.org

● Work: 501-562-5223 ● FAX: 501-562-5877

● Check out our website: www.positivekids.org
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2025-2026 NOMINATION FORM