Pathway Interest Form 2018-2019

Which MetroSquash location are you interested in?

Student First Name

Student Last Name

Birthdate

School (in Fall 2018)

Grade (in Fall 2018)

Time Student Can Arrive to MetroSquash on Weekdays:

Please list any extracurricular activities and tentative schedules.

Please write any accommodations we should take into consideration to better support your student.

Examples: My student has asthma and carries an inhaler. My student has a history of anxiety.

Student Demographics

Ethnicity

Gender

Free/Reduced Lunch

Family Financial Statement

MetroSquash's mission is to serve Chicagoland students who need the program the most. We therefore ask each family to provide financial information and include this metric in our selection criteria. All information provided to MetroSquash is kept strictly confidential.

In the space below, please explain the status of your family’s finances. Information should include: yearly income and number of individuals in your household but can also include a description about parenting status, free/reduced lunch, financial government assistance, debt, or any other extenuating circumstances.

Household Income Per Year

Number of People in Household

Additional Information

Family Financial Statement

MetroSquash's mission is to serve Chicagoland students who need the program the most. We therefore ask each family to provide a copy of their most recent W2 in addition to the financial information below. We will include this metric in our selection criteria. Additional documentation may be requested. All information provided to MetroSquash is kept strictly confidential.

Household Income Per Year

Number of People in Household

Additional Information

Mailing Address

City

State

Postal Code

Guardian 1 Information

Guardian 1 First Name

Guardian 1 Last Name

Relationship to Student

Phone Number

Okay to Text?

Highest Level of Education Completed

Guardian 2 Information (if applicable)

Guardian 2 First Name

Guardian 2 Last Name

Relationship to Student

Phone Number

Okay to Text?

Highest Level of Education Completed

Which tryout date would you prefer? We ask both the student and the guardian to stay for the entire duration of the tryout. Students should wear athletic clothing for the tryout.

Contact Information