CLC Enrollment Form
Thank you for your interest in CLC
Privacy and Confidentiality Statement
CLC is a nonprofit organization dedicated to accessible education. We value your privacy and are committed to protecting your personal information. We do not sell, share, or disclose your information to third parties.. If you have any questions about how your information will be used, please contact us at admin@clcsummit.com
Student and Parent Information:
Student Legal Name
*
First Name
Last Name
Has your student attended CLC in the past 3 years
Yes
No
Other
Student Preferred Name
Student Preferred Pronouns (Optional)
Student Date of Birth
-
Month
-
Day
Year
Date
What year is your child expected to graduate highschool?
(Optional) Does your child have any allergies, medical conditions, or special needs we should be aware of to ensure their safety and comfort?
Parent/Legal Guardian Name
*
First Name
Last Name
Parent Email (This is how we will send scheduling information and Invoices)
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Preferred Method of Communication
*
Email
Call
Text
Other
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Optional: Add additional Parent/Guardian
Would you like both parents/guardians to receive all email communications?
*
Yes
No
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Student's Current School
*
Please Select
Breckenridge Elementary
Dillon Vallet Elementary
Frisco Elementary
Homeschool
Silverthorne Elementary
Summit Cove Elementary
Upper Blue Elementary
The Peak School
Snow Peaks Highschool
Summit Highschool
Student Grade
*
Student Learning Format
In Person
Remote
Preferred Tutoring Format
*
In Person
Remote
What subjects does your student need assistance with?
Eg. Math (Pre-Algebra, Algebra, Pre-Calc) Reading, Writing, History, English Language Arts, Foreign Language, English as a Second Language, ACT/SAT, College Consulting
Is there anything else you would like us to know about your student or their academic history?
*IEP and 504 information can be provided on the next page
Preferred Day for Tutoring/Services (Can be multiple)
Monday
Tuesday
Wednesday
Thursday
Friday
Other
Preferred Start Time (Can be multiple)
Before School (6am - 7am)
During School Hours (8am - 2pm)
3:30pm
4:30pm
5:30pm
6:00pm or later
Other
Preferred Tutor (Optional)
Please Review our Policies and sign below:
Signature
*
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If your student has an IEP or 504 plan please fill out this page:
If your student does not have an IEP or 504 you can skip this page
My student has:
Please Select
IEP
504 Plan
Upload Plan here (if finalized)
Browse Files
Cancel
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Is there anything else you would like us to know about your student's IEP or 504 plan?
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Demographics
This information helps us better understand the communities we serve (e.g., grant reporting, tailoring services, and demographic tracking) Providing this information is optional.
Please select the race/ethnicity that best describes your child.
White/Caucasian
Hispanic/Latino
Asian
Native American or Alaska Native
Prefer not to disclose
Other
Does your family receive or qualify for reduced or free lunches?
Yes
No
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How did you hear about us?
Google
Word of Mouth
Social Media
School Referral
Community Event (ex. First Friday, School fair)
Other Non-profit
Other
Would you like to join our mailing list for monthly newsletter and special offers?
Yes, sign me up!
Would you like information about our scholarship/discounted tutoring program? (Availability is limited and based on income, demographics, and academic need)
Yes
No
Other
Submit
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