Fostering Change Initiative Registration Form

1
What program are you attending?* This field is required.
Fostering Success
Summer Strategy
2
Student's Last Name* This field is required.
3
Student's Suffix (ex. Jr., Sr., II, III, IV)
II
III
IV
Jr
Sr
4
Gender* This field is required.
Male
Female
5
Birth Date* This field is required.
Month
Day
Year
6
Address* This field is required.
7
City* This field is required.
8
State* This field is required.
AL
AK
AR
AZ
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MY
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WY
9
Zip* This field is required.
10
Student Cell Phone* This field is required.
11
Current Grade Level* This field is required.
9th
10th
11th
12th
12
What high school do you attend?* This field is required.Name and City
13
Year of Graduation* This field is required.
2023
2024
2025
2026
2027
2028
14
Parent/Legal Guardian* This field is required.
15
Relation* This field is required.
16
Cell Phone* This field is required.
17
Student's Email
example@example.com
18
How did you hear about Homes for Children?
Friend
Church
Web
Promotional Event
Other
Should be Empty: