2026 Transitional Pathways Program Registration Form

Parent/Guardian Information
Please have your parent or guardian fill out the following section, or complete it with them.
Parent/Guardian English Name*

First NameLast Name
Parent/Guardian Phone Number *
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email*
example@example.com
By providing us with your email or phone number through this form you authorize us to contact you by phone or email.
By checking the box below, you agree to receive text messages from the Korean Community Service Center at the phone numbers provided. Message frequency varies. Message & data rates may apply. Reply HELP for help. Reply STOP to opt out.
SMS Sharing Disclosure SMS 정보 공유 공개

No mobile information will be shared with other parties for marketing/promotional purposes at any time.

Learn more about our 개인정보 처리방침 Privacy Policy

Emergency Contact Information
Emergency Contact Name *

First NameLast Name
Relationship to Youth*
Emergency Contact's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Medical Information

This information is confidential and will be referenced for in-person settings. You are welcome to share as much or as little as you would like.
Student Disability Accessibility Needs: We recognize that people have different abilities and needs. What do we need to be aware of to make this program accessible for your student? (Please email kcscyouthprograms@gmail.com if you would rather email this information)*

0/500
Food, medication or environmental allergies.*

0/500
Any physical, mental, or other condition that would require special attention or medication?*

0/500
YesNo

Student Short Answer Questions

Please answer the following questions in your own words. We encourage you to write in your own words when completing the questions below. Responses do not need to be lengthy; what matters most is that they clearly reflect your individual voice and perspective.
How do you typically respond to periods of stress or uncertainity, and what strategies have helped you navigate change?*
What is a challenge you or your peers are currently facing during this stage of transition, and how do you think it can be better supported?*
As you think about this next chapter of your life, what excites you the most? What feels uncertain or difficult?*
What would make this program a meaningful and valuable experience for you?*

Payment and Acknowledgement
I understand that Korean Community Service Center is unable to process refunds for this program.The student named above commits to attending Korean Community Service Center's Transitional Pathways program from July 30 - Aug 3, 2026.
Receipt Email Address*
We'll send your Square receipt to this email

Payment*

2026 Transitional Pathways Registration Fee

If you are in need of a scholarship please email kcscyouthprograms@gmail.com.

$75.00 Quantity
Item subtotal:$0.00

Total

$0.00

Transitional Pathways Program for Asian American Young Adults