Launch to Success Application

Please complete this form in its entirety.

Section I: General Information

First Name
Last Name
Address
Cell Number
Alternate Number
Email
Best Time / Number to Contact

Section II: Responsible Party Information

Parent / Guardian (1)
Relation to Student (1)
Address (1)
Home Number (1)
Work Number (1)
Mobile Number (1)
Occupation / Employer / Highest level of education (1)
Email addresses (1)
Parent / Guardian (2)
Relation to Student (2)
Address (2)
Home Number (2)
Work Number (2)
Mobile Number (2)
Occupation / Employer / Highest level of education (2)
Email addresses (2)

Section III: Emergency Contact

Name
Phone
Relationship

Section IV: Information on Exceeding the Mark

How did you hear about us?
Other
What has encouraged you to join the Exceeding The Mark team?

Section V: Information for Program

What are some of your child’s interests or hobbies?
What are your child’s current grades (Please list all grades next to the subject)?
What are your child’s strengths?
What are your child’s weaknesses?
What is your expectation of the Launch to Success program?
What profession is of interest to your child?
Is there anything else you would like to share with us about your child?

Section VI: Availability

Please list preferred days and/or times for which your child would be available to participate in activities.
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If you're interested in getting involved with ETM, please contact us at info@exceedingthemark.org.