My Sister is Succeeding Application for Grades 6-8 Participants's Name(Required) First Last Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Grade in School(Required) 6th 7th 8th 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 place 11 Wednesdays 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 after-school activities that may cause them to participate only part of the year. Please check all that apply. Let us know your transportation availability.(Required) I will bring my child and pick up my child. I'd like my teen to ride transportation from BGJHS or Moss (if available), and I will pick her up. If bus drivers become unavailable, my teen still has transportation to attend. Are you able to attend the Parent/Guardian Overview Meeting on October 9th at 7:00pm via Zoom. Yes. I am available. I am unavailable. 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 your teen? Participants are asked to write a "Dear Future Me" letter as part of the registration. Please add the letter here or send it via email to [email protected] by October 1.Registration Fee: The registration fee is $25 for the academic year. Please let us know your preferred method of payment.(Required) We will send $25 via Cash App $forarealchange We will send $25 via Venmo @forarealchange We will send $25 via PayPal - https://www.paypal.com/paypalme/forarealchange BGJHS - sponsored 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.
