After School 2017-2018 Application

Filling out this form does not guarantee acceptance into the program. Current or prior enrollment also does not guarantee acceptance into the program. If accepted into the program, you will receive confirmation prior to the mandatory orientation. To qualify, a student must live in an area zoned for a school in the East End of the city of Richmond. However, they do not need to attend that school. Our program serves 2nd through 12th grade students.

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1. Primary Parent or Guardian Information

Name

Address

City/Town

Phone Number

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2. Student First Name

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3. Student Last Name

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4. What School Does Your Student Attend? (2017-2018)

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5. Your Student's Grade (2017-2018)

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6. In What Neighborhood Does the Student Live?

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7. Did Student Attended Peter Paul Last School Year or This Summer?

Yes!

No, This Student Has Never Attended a Peter Paul Program

No, But This Student Has Attended a Peter Paul Program in the Past