2026 FBCH Freedom School Scholar Application

The Freedom School is an educational and cultural enrichment program that lets young people (known as "Scholars") know they can make a difference in themselves, their families, schools, communities, country, and world through hope, education, and action. Our primary focus on literacy and culture encourages curiosity while having fun. Applications are due on Monday, February 16 and will be reviewed and accepted on a first come, first served basis.
Parent/Guardian Information
Parent 1: Full Name
Address
City
State
Zip Code
Cell Phone Number
Email Address
example@example.com
Parent 2: Full Name
Address
City
State
Zip Code
Cell Phone Number
Email Address
example@example.com
Scholar Information

Please provide information for every child you wish to apply for the program.
Scholar 1: Full Name
Address
Date of Birth
Gender Identity (select one):*

MaleFemaleOther
Race (select one):*

AsianBlack or African AmericanHispanic/LatinoWhiteOther
What school does your child currently attend?
Grade Entering for the 2026/2027 School Year:
What are your family's reading habits? For example, Do you read to your child? If so, how often? Do you or your child read on your own (for school, work, or pleasure)?
The Freedom School Program is designed for Scholars who are able to work comfortably in a group activity setting. We do not have the capacity to work one-on-one with Scholars. Has your child experienced or is currently experiencing any of the following:

IEP at schoolADD/ADHDAnxietyBehavioral ConcernsSensory ProcessingDepressionDevelopmental DelaysMental Health IssuesPTSDSPD/OCD/ODDAsthma/InhalerRespiratory AilmentsConstipation/DiarrheaUses eyeglasses or contactsHearing ProblemsDiabetesEpilepsyMotion SicknessSkin ProblemsAutismFood AllergiesAdaptive Equipment
If you answer yes to any of the above, please explain and also share any medication or additional assistance needed.
Scholar 2: Full Name
Address
Date of Birth
Gender Identity (select one):

MaleFemaleOther
Race

AsianBlack or African AmericanHispanic/LatinoWhiteOther
What school does your child currently attend?
Grade Entering for the 2026/2027 School Year:
What are your family's reading habits? For example, Do you read to your child? If so, how often? Do you or your child read on your own (for school, work, or pleasure)?
The Freedom School Program is designed for Scholars who are able to work comfortably in a group activity setting. We do not have the capacity to work one-on-one with Scholars. Has your child experienced or is currently experiencing any of the following:

IEP at schoolADD/ADHDAnxietyBehavioral ConcernsSensory ProcessingDepressionDevelopmental DelaysMental Health IssuesPTSDSPD/OCD/ODDAsthma/InhalerRespiratory AilmentsConstipation/DiarrheaUses eyeglasses or contactsHearing ProblemsDiabetesEpilepsyMotion SicknessSkin ProblemsAutismFood AllergiesAdaptive Equipment
If you answer yes to any of the above, please explain and also share any medication or additional assistance needed.
Scholar 3: Full Name
Address
Date of Birth
Race (select one):

AsianBlack or African AmericanHispanic/LatinoWhiteOther
Gender Identity (select one):

MaleFemaleOther
Grade Entering for the 2026/2027 School Year:
What school does your child currently attend?
What are your family's reading habits? For example, Do you read to your child? If so, how often? Do you or your child read on your own (for school, work, or pleasure)?
The Freedom School Program is designed for Scholars who are able to work comfortably in a group activity setting. We do not have the capacity to work one-on-one with Scholars. Has your child experienced or is currently experiencing any of the following:

IEP at schoolADD/ADHDAnxietyBehavioral ConcernsSensory ProcessingDepressionDevelopmental DelaysMental Health IssuesPTSDSPD/OCD/ODDAsthma/InhalerRespiratory AilmentsConstipation/DiarrheaUses eyeglasses or contactsHearing ProblemsDiabetesEpilepsyMotion SicknessSkin ProblemsAutismFood AllergiesAdaptive Equipment
If you answer yes to any of the above, please explain and also share any medication or additional assistance needed.
Commitment

This program requires a time commitment of 6 weeks for all scholars. Scholars get the most out of the program if they are able to attend all sessions. Can you commit to your scholar attending for the entire six weeks?
Are you able to make this commitment?

YesNo
Additionally, to get the most out of the Freedom School experience it's imperative the family be fully involved. Parents/guardians are required to attend a weekly parent meeting that is held at 3:00 p.m. on Wednesdays or volunteer for 2 hours during the program day if meetings are missed. Are you willing to commit to being an engaged Freedom School parent/guardian?
Are you able to make this commitment?

YesNo
Should be Empty:

Parent/Guardian Information

Scholar Information

Commitment