Exceeding The Mark

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.
Enter the text in displayed in the image	Not readable? Change text.

Launch to Success Application