24-25 Intensive Excellence Program

24-25 Intensive Excellence Program Application

Parents and Students, please fill out the application to the best of your ability and truthfully. This application will help us to plan activities, field trips, and partnerships based on the student's interest. Thank you for choosing to be a part of EXCELLENCE!
Student Information

This first section will be personal and educational questions about the student.
Student Name*

First NameLast Name
Student E-mail*
example@example.com
Student Phone Number *
Student's Grade *
Name of School Attending *
Current GPA *
What is your WEAKEST subject? *
What is your STRONGEST subject? *
T-Shirt Size *
These are adult/unisex sizes
Student Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Birth Date*

MonthDayYear
Where did you hear about us?*

Someone Referred YouGoogleFacebookInstagramAn EventOther
If someone referred you, please list their name below.
Is Student in IEP or Special Education*

IEPSpecial EducationNeither
Does Student receive Free or Reduced Lunch?*

YesNo
Any Allergies?*
If student does NOT have any allergies enter NONE in box above.
Does student have internet access at home?

YesNo
Does Student have a history of physical, gun/knife, gang violence?*

YesNo
If YES to the answer above, please explain in detail the situation.
In the past year, was Student expelled or suspended from school or other program(s)?*

YesNo
If YES to the answer above, please explain in detail the situation.
Student Interests

Let's get to know you better. These questions are to help us design a program that every student will be able to enjoy.
What is your dream career?*
What is your dream college/university?*
If you do NOT have a dream college/university, please put NONE in box.
What is your favorite restaurant?*
What is your favorite snack?*
What do you want to learn most in this program?*
For example, do you want to learn how to get a job, personal finance, domestic skills like cooking and cleaning, etc.
Favorite educational place to visit? *
Educational places such as: Greenville Zoo, a museum, etc.
List 3 to 5 goals (big or small) that you would like to achieve by summer of 2025? *
Describe yourself?*
Give us an insight on your personality. For example, are you an extrovert that loves to start a conversation or an introvert that loves to sit back and analyze the room.
Parent/Guardian Information
Name of Parent/Guardian*

First NameLast Name
Email of Parnet/Guardian *
example@example.com
Phone Number of Parent/Guardian*
Please enter a valid phone number.
Permanent Address of Parent/Guardian*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of People in Household *
Household Income *
This question is asked to get for our data purposes.
Parent/Guardian Interests for the Student

Parents, we would love to know what you would like your student to take from this program to make this a program you can be proud of as well.
What are some life skills you would like your child to learn?*
How would you describe your child?*
What would you like your child to be better at? *
Program Orientation Details & Other Information

Please read the information below to see what is up next for parents and students.
1. Program Orientation is Sunday, August 25th, 2024. Parents who submit a completed application will receive detailed emails about the orientation. It is REQUIRED to have the application completed before orientation.

2. Students will recieve welcome packets containing further documents for parents and students to sign at the orientation.

3. First day of the program will be Sunday, September 8th, 2024.

4. Please note that all information on this application is completely confidential along with information given to us during the duration or the program.
Please check the box if read and understood the next steps of the orientation and other information.

I have read, understood, and accepted the rules for membership.
Parent/Guardian Signature

Clear

My Products*

Student Application Fee This is a nonrefundable fee.

$20.00 Quantity

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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24-25 Intensive Excellence Program Application

Student Information

Student Interests

Parent/Guardian Information

Parent/Guardian Interests for the Student

Program Orientation Details & Other Information