Good Sam FRC Youth Services Program Interest Form
Are you a community organization or an interested participant?
¿Es usted parte de una o
rganización
de la comunidad o un participante interesado?
Community organization
O
rganización
de la Comunidad
Interested participant (student/legal guardian)
Participante interesado (estudiante/tutor legal)
Partner Organization Information
Name of the Organization
Nombre de la organización
Email of the staff completing this referral
Correo electrónico del personal que completa esta referencia
Today's Date
Fecha
Student Information
Student's First Name
Nombre del estudiante
Student's Last Name
Apellido del estudiante
Parent/Legal Guardian First Name
Nombre del padre/tutor legal
Parent/Legal Guardian Last Name
Apellido del padre/tutor legal
Parent/Legal Guardian Phone Number
Número de teléfono del padre/tutor legal
Parent/Legal Guardian Email Address
Dirección de correo electrónico del padre/tutor legal
Enrollment Priority
Please answer the following to help us determine the student's enrollment priority:
Por favor responda lo siguiente para ayudarnos a determinar la prioridad de inscripción del estudiante:
What is the student's current housing status?
¿Cuál es el estado actual de vivienda del estudiante?
Please select...
Permanent/Stable Housing
Homeless - Transitional/Supportive Housing
Homeless - Shelter/Emergency Housing
Homeless - Motel/Hotel
Homeless -Staying with Friends/Family/Doubled-up
Homeless - Unsheltered
Unknown
Student currently enrolled in SFUSD school?
¿Estudiante actualmente matriculado en la escuela SFUSD?
Yes
No
Student currently in foster care?
¿Estudiante actualmente en cuidado de crianza?
Yes
No
Program/Service of Interest
Which Summer program(s) is the student interested in?
¿En qué programa(s) está interesado el estudiante?
Please select...
Good Samaritan Soccer Summer Camp for 1-5 grade
Jardin Secreto Summer Camp for 1-5 grade
Mission Mapaches Summer Camp - Middle School
Mission Mapaches Summer Camp - High School
Vision Academy Summer Camp for K-8 grade
Willie Brown Middle School Summer Learning Camp
Which School Year program(s) is the student interested in?
¿En qué programa(s) está interesado el estudiante?
Please select...
Willie Brown After School for grade 6-8
Vision Academy for grade K-8
Latinx Services - Everett MS
Latinx Services - Mission Ed. Center
Latinx Services - Thurgood
Latinx Services - James Lick
Latinx Services - SFIHS
Notes
Notas
Contact Information