Language
English (US)
Spanish (Latin America)
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 Name
Last Name
Relationship to Child
Caregiver #2 (optional)
First Name
Last Name
Relationship to Child
Preferred Language(s)
English
Spanish
Other
Caregiver Primary E-mail
*
example@example.com
Caregiver Primary Phone Number
Format: (000) 000-0000.
Burtonsville Elementary Student?
*
Please Select
Yes
No
Other
Preferred Start Date
Student's School Year
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Preferred Program Schedule - School Year (Starting Sept 2, 2025)
*
M-F AM & PM
M-F AM Only (7-9am)
M-F PM Only (3:45-6pm)
Preferred Care Schedule - Summer (Jun 18 - Aug 15, 2025) 7:30am - 6pm
*
Full Day: M-F
Part Day: Set Schedule
Changes Weekly/Monthly
Other
Not Needed
Scholarships are based on benefits your family receives, does your family receive any of the following benefits?
SNAP
MdFARM
Medicaid
Prefer to discuss during meeting
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!
Submit Application
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