P.A.R.K.'s Prospective Student Information Request

Prospective Student Information Request

Please complete the information below to stay updated with the latest happenings at P.A.R.K. and to have P.A.R.K. staff reach out to you once your child become eligible for entry into our program.
Please Note: To be eligible for nomination into P.A.R.K., students must
- be currently in the 7th or 8th grade
- be enrolled in a partner LRSD or PCSSD middle schoool
- have between a 1.8 to 2.8 g.p.a. in their core subjects for 1st or 2nd nine weeks
- complete a nomination form (from either their school or using our digital link)
Name of Student *
Student's Current School *
Student's current grade: *
Date of Birth *
Example: 05/16/03
Gender: *

Male Female
Race
Ethnicity
Parent/Guardian(s) Name: *

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

Yes No
Email Address
example@example.com
Would you like to receive email communication?

Yes No
Mailing Address *

Street Address

Street Address Line 2/Apartment Number

City State / Province

Postal / Zip Code
How did you hear about P.A.R.K.? *
If you selected "Other" for the previous question, please explain how you first heard about P.A.R.K.
Date
Please Note: By submitting this form, you are agreeing to receive email communications from P.A.R.K. using the information provided on this form.
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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