Building Better Futures 2021-2022 Registration Form

This registration form is for parents/students interested in joining the Building Better Futures Program for the 2021-2022 school year. Fall programming will be hybrid.

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* 1. Relationship to applicant.

Student- Please fill out this section with the student's information.

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* 2. Student

First Name

Last Name

Birth Date

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* 3. Gender

Additional category (please specify)

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* 4. Current Grade

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* 5. Home Campus

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* 6. Ethnicity (Please select only one)

Other (please specify)

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* 7. Birth Country

Other (please specify)

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* 8. Language Spoken At Home

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* 9. Do you currently receive free/reduced lunch? Make the selection below.

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* 10. Allergy/Dietary Restrictions? If so, list below.

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* 11. How many members do you have in your household? (including parents, siblings, grandparents, etc.)

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* 12. What is your household income level? Please provide the total income of all working members in your household. (Later in the registration process, we will ask you for the proof of household income)

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* 13. Will you be a 1st generation college student?

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* 14. School Counselor's Name

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* 15. Has the student or anyone in the student's household participated in any other Campagna Center programs?

Yes

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* 16. If yes, what program?

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* 17. Is the student in the International Academy? Make selection below.

Yes

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* 18. I would like to register the student for the following BBF programs. (Select all that apply)

Tutoring 9th-12th grade (Yearlong- Homework Help, Test Prep, Essay Assistance)

Enrichment 9th-12th grade (College/Career Planning, College Tours, Job Shadowing)

Senior Seminar 12th Grade Only (Assistance with college essays, completing FAFSA, scholarship applications)

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* 19. How did the student hear about BBF?

Other (please specify)

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* 20. Student Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Student Cell Phone *

Student TC email *

Student Personal Email *

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* 21. Is it okay to text you?

Yes

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* 22. What method of communication do you prefer?

Text message

Both