Raise Up Student Application Form

Raise Up Application

Please fill out the following information below.

First Name

Last Name

Street Address

Birthdate

SSN

City

Zip Code

Phone Number

Please fill out your parent's or guardian's information below.

Parent/Guardian 1

Parent/Guardian 1 Phone

Parent/Guardian 1 Street Address

Parent/Guardian 1 Email

Parent/Guardian 2

Parent/Guardian 2 Phone

Parent/Guardian 2 Street Address

Parent/Guardian 2 Email

Please list your current after school activities.

Name of Activity

Day and Time

Please write an essay (up to 500 words). You may write directly in the box below or attach a Word document. Please answer the following questions:

What are your goals for your future?
What decisions and actions do you currently take in order to achieve your goals?
Why do you think you should be selected for Raise Up?

Essay

Raise Up Student Application Form.