2023-2024 P.A.R.K. Student Nomination Form

2023-2024 NOMINATION FORM

This form will nominate students for entry into P.A.R.K.'s 2024 probationary summer program, and subsequently, 2024-2025 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.

Early Selection Deadline is Friday, December 8, 2023.

Final Nomination Deadline is Friday, March 8, 2024.
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 SchoolingVirtual 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 Here (Please note: student nominations are not complete until we receive a report card from the CURRENT school year.)

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

To access student's report cards Clear
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.
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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2023-2024 NOMINATION FORM