Interest Form 2022-2023

The Skill Builder’s after-school program provides care for children with special needs in the Coachella Valley. Programs operate twice a week during after-school hours for participants ages 7 to 22.

For more information about our program visit our website: UCPIE After School Program

If interested in enrolling your child, please complete the interest form below. Your responses will help us determine the number of prospective participants which will help guide decisions pertaining to the number of sites to open and their location(s).

NOTICE: We want to clarify that the submission of this form does not confirm your child is enrolled in the program.

We are moving forward with our enrollment planning process for the 2022- 2023 school year with hope that we are able to operate a regular or adjusted program. This form will add your child to the interest list. A formal intake and enrollment process will follow. We appreciate your interest and thank you for taking the time to complete the form below. 

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* 1. What is your name? (Parent/ Guardian).  Nombre del Padre o Guardian

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* 2. Phone number/ Numero de telefono

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* 3. E-mail/ Correo Electronico

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* 4. What is your child's name?/ Nombre del Niño(a)?

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* 5. What school district does your child currently attend? / A que Distrito escolar asiste su hijo(a).

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* 6. What school will your child be attending in the 2022-2023 school year? / A que escuela va asistir su hijo(a) en el año escolar 2022-2023?

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* 7. Which projected location would you like your child to attend?/ ¿A qué lugar proyectado le gustaría que asistiera su hijo?

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* 8. At what time will your child start school and at what time will he/she get out from school in the 2022-2023 school year? / A que hora su hijo(a) entrara a la escuela y a que hora saldra en el año escolar 2022-2023

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* 9. Has your child been vaccinated against COVID-19? Su ñino(a) esta vacunado contra el COVID?

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* 10. We currently offer an after school Virtual Program. Would you be interested in your child participating in the virtual zoom activities this summer? /Actualmente ofrecemos un programa virtual después de la escuela. ¿Le interesaría que su hijo participara en las actividades virtuales de zoom este verano?

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* 11. I understand that by completing this form, it does not guarantee my child(ren) placement into the afterschool program. / Entiendo que completar este formulario no garantiza la ubicación de mi(s) hijo(s) en el programa extracurricular.

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