Blueprint:College 2024

Blueprint:College is an engagement program for 9th and 10th Grade families to support student's plans and educational achievements. This program will highlight needed steps for students and families to take to ensure students are successful throguhout high school, prepared for high school graduation, and understand postsecondary options!

Breakfast or Dinner will be provided and each family will receive a $25 gift card for attending.

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email*

example@example.com

Parent/Guardian Phone Number*

Please enter a valid phone number.

Student Name*

First NameLast Name

Student Email*

example@example.com

Student Cell Phone Number*

Please enter a valid phone number.

Student Grade Level*

9th Grade10th Grade

Student High School*

Student HS ID Number*

Which Blueprint:College Program will you attend?*

Thursday, April 4th @ The Ohio State University 4:30 p.m.-8:00 p.m.Saturday, May 4th @ Capital University 8:30 a.m.- 12:00 p.m.

Will your student attend the workshop with you?*

YesNo

Will an additional parent/guardian (not listed above) attend? If yes, please list their First and Last Name.

Dietary Restrictions *

Are you in need of an English Interpreter? If yes, what language?

We will do our best to provide an interpreter in your needed language, but cannot guarantee.

Do you need transportation assistance to the program?*

YesNo

Program Agreement, Consent, and Release Statement

By submitting this form, I hereby affirm that all of the information provided herein is true and complete to the best of my knowledge. I fully understand that providing false information and/or failing to provide all required materials may result in my disqualification of consideration for receipt of any I Know I Can financial assistance and/or continued services provided by I Know I Can. Further, I hereby grant full authorization to I Know I Can, and its representatives, to use any and all information contained in all related documents and/or academic records provided for any and all relevant purposes, including, but not limited to 1.) financial assistance eligibility and/or selection purposes; 2.) overall monitoring of the student’s academic progress to ensure continued assistance support, and maintained success of the student’s educational pursuit; and 3.) any and all research, evaluation, and/or solicitation of support conducted by I Know I Can. I Know I Can, its representatives, community partners, and appropriate district personnel employed at the student’s school in the areas pertaining to academic progress, postsecondary success, and any and all other related programs and/or areas may share any and all relevant information for any and all of the aforementioned purposes. I understand that in the selection of financial assistance recipients, I Know I Can does not discriminate on the basis of gender, ethnic heritage, national origin, personal appearance, personal beliefs, race, religion, or sexual orientation. By signing this application, the undersigned hereby acknowledges receipt and understanding of the guidelines set forth herein and agrees to abide by the same. Further, the undersigned agrees to waive all personal claims, causes of action, and/or damages against I Know I Can and any and all of its representatives, including, but not limited to, its board of trustees, officers, employees, and associates, arising from or growing out of their participation in I Know I Can.