My Sister is Succeeding High School Registration Participants's Name(Required) First Last Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Grade in School(Required) 9th 10th 11th 12th School(Required) Parent / Guardian First and Last Name(Required) Parent/Guardian Email(Required) Enter Email Confirm Email Parent/Guardian Phone Number(Required)Parent / Guardian Name #2 Parent / Guardian #2 Email Address Parent / Guardian #2 Phone Number Email Address of the ParticipantPlease include the participant's email if the participant would like to receive email communications in addition to the parent/guardian. My Sister is Succeeding takes over place 8 Saturdays during the school year. Please let us know if there are any dates that your teen WILL NOT be present or if your child participates in any extra-curricular activities that may cause them to participate only part of the year. Will the participant be driving themselves?(Required) Yes. The participant will drive themselves and park on campus. No. Other Shirt Size(Required) Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL What is the academic or career field interest of the participant? Please let us know why you believe MySiS may be beneficial for the participant.(Required)Participants are asked to write a letter as part of the registration, which finishes this sentence: "I will succeed because...". Please add the letter here or send it via email to [email protected] by October 10.Teacher Recommendation: Please list the name of the teacher(s) that recommended you for MySiS. Are you able to attend the Parent/Guardian Overview Meeting on October 10th at 7:00pm via Zoom.(Required) Yes. I am unavailable Other Upon being accepting into the My Sister is Succeeding High School Program, a registration fee of $25 will be due. Please mark your preferred method of payment.(Required) Upon enrollment, we will send $25 via Cash App $forarealchange Upon enrollment, we will send $25 via Venmo @forarealchange Upon enrollment, we will send $25 via PayPal at https://www.paypal.com/paypalme/forarealchange Please let me know if there are any options for assistance with the registration fee. Additional Information (Optional)The below information is optional and will be used for grant-writing purposes. Did either parent of the participant graduate from a four-year college? Yes No Race / Ethnicity Black / African American Bi-racial / Multi-racial Hispanic / Latina Native American Asian / Asian American Hawaiian / Pacific Islander White / Caucasian Other Does the participant qualify for free or reduced lunch? Yes. No Section BreakPlease tell us more about your teen.Please let us know if you teen has any special dietary or accessibility needs. Please let us know if your teen is academically advanced or has any learning challenges or IEPs. Consent: Please check if you consent. I understand that the participant registered on this form will be participating in My Sister is Succeeding by For a Real Change. By agreeing here, I understand that the photos taken during the program may be used for promotional purposes by For a real Change, Inc and WKU. Prior to the first day, I will review the consent waiver and sign upon agreeance.
