TFA Interest Form

TF&C Interest Form

Empowering Kids to Thrive - One Family at a time
Let's Get to Know Each Other

Please fill out this interest form to be contacted about one of our elementary age full or part-time spaces. After this form is submitted, we will contact you to schedule a 30 min virtual meeting to get to know your family. We will discuss your family's needs and our mentoring philosophy.
Caregiver Name

First NameLast NameRelationship to Child
Caregiver #2 (optional)

First NameLast NameRelationship to Child
Preferred Language(s)
Caregiver Primary E-mail
example@example.com
Caregiver Primary Phone Number
Format: (000) 000-0000.
Burtonsville Elementary Student?
Preferred Start Date
Student's School Year
Preferred Program Schedule - School Year (Starting Sept 2, 2025)
Preferred Care Schedule - Summer (Jun 18 - Aug 15, 2025) 7:30am - 6pm
Scholarships are based on benefits your family receives, does your family receive any of the following benefits?
If you qualify for a scholarship, what is your family able to spend on this mentorship weekly? (Montgomery County average is $165/wk)
Top Three Needs to be Met for Your Kid(s) to Thrive with TF&C
How can we best support your child and family?
Questions for Us
We would love to answer any questions you have!
Should be Empty:

TF&C Interest Form