Crosby Scholars LIGHHT Application

Crosby Scholars LIGHHT Application

This application is for LIGHHT eligible students only. There are three sections: Student, Parent/Guardian, and Social Worker
If you have any questions about the application, please email Carloe Moser- LIGHHT Program Coordinator

Student Section
Student Name

First NameLast Name
Student E-mail Address
example@example.com
Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Race (Optional)

Other
Student Gender (Optional)
Student Date of Birth

MonthDayYear
Date
Student Phone Number (optional but recommended)
Please enter a valid phone number.Format: (000) 000-0000.

Do you attend a school in WSFCS? (as of today)

Student ID Number
Grade
WSFCS Middle Schools
WSFCS High Schools

Student ID Number
You can skip if you do not know
Grade
Please type the middle school you attend
Please type the high school you attend

Parent/Guardian Section
Is your Parent/Guardian currently with you?
What is your Parent/Guardian's E-mail?
example@example.com

Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Email
example@example.com
Parent/Guardian's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian's Signature
Date

MonthDayYear
Date

Social Worker Section
Is your Social Worker currently with you?
What is your Social Worker's E-mail?
example@example.com

Social Worker's Name

First NameLast Name
Social Worker's Email
example@example.com
Social Worker's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Social Worker's Signature
Date

MonthDayYear
Date

Please review your application before submitting it
Should be Empty: