BRIDGE Scholars After-School Program Interest Form
Thank you for your interest in the Bridge Scholars After-School Program. This form helps us learn more about your child and your family as we prepare for upcoming enrollment opportunities.
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Preferred Method of Contact?
Phone Call
Text Message
Email
Student Name
*
First Name
Last Name
Student's Current School
*
Student's Current Grade
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
What interests you most about the Bridge Scholars program? CheckBoxes (allow Multiple)
*
Academic support and tutoring
Leadership and character development
STEM and enrichment activities
Mentorship and positiive role models
A safe, structured after-school environment
What are your primary goals for your child in an after-school program?
Are you open to participating in an information meeting or orientation if invited?
*
Yes
Possibly
Not at this time
How did you hear about BRIDGE Scholars?
School
Friend / Family
Church
Community Partner
Flyer
Social Media
Other
Bridge Scholars partners with families in a variety of ways. Are you open to learning about additional family supports that may be available during enrollment?
Yes
Possibly
No
Anything else you would like us to know about your child or family?
Please acknowledge the following: * I understand that completing this form does not guarantee placement and that program details and eligibility will be shared during the enrollment process.
*
Yes
Submit
Should be Empty: