Hilltop Artists Program Application

STUDENT INFORMATION

Please select your language:

You are Applying For:

First Name

MI

Last Name

Birthdate

Current Grade

You do not meet the minimum grade level for this program

What type of school is the student enrolled at?

What school is the student enrolled at this semester?

If other, please list school or program child attends

Do you know your student's school ID number

YesNo

What is the student's school ID number?

Gender Identity

Gender Description

Pronouns

I am OK sharing my racial identityPrefer not to disclose racial identity

Hidden Details

Schedule ID

Sched Name

Program ID

Sched Start

Sched End

Student 1 ID

Sched 1 ID

Application Link

GradeLevel

Minus1

Student Phone

Student Email

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Who does the student primarily live with?

Please specify:

Home Language

Address

Street Address

City

Country

State

Provinces

State/Province

Zip/Postal Code

Does the student have mental or physical health issues we should be aware of?

Please describe those issues here:

Please list any additional medical information that could be important to your child

Student's Primary Doctor's Name

Doctor's Phone

Emergency Contact 1 Name (not parent/guardian)

Emergency Contact 1 Phone

Emergency Contact 1 Relation to Student

Are any of the student's immediate family active-duty military?

Are any of the student's immediate family military veterans?

Has the student participated in a Hilltop Artists program in the past?

Student is brand new to glassblowing

Student has taken over 1 year of glassblowing classes

Please have your student answer these questions to the best of their abilities

What excites you about joining after-school programs at Hilltop Artists?

Our program often asks you to work as part of a team. How do you feel about meeting new people and working in groups?

Are you participating in any other activities this semester? If so, what, and when are they?

GUARDIAN INFORMATION

First Name

Last Name

Email

Would you like to receive our email newsletter?

Mobile

Home Phone

Relationship to Student(s)

Is your address the same as the student address?

Parent/Guardian Address

Street Address

City

Country

State

Province

Zipcode

American Indian or Alaskan Native	Asian
Black or African American	Native Hawaiian or Other Pacific Islander
White/Caucasian	Middle Eastern/North African
Latina/o/x/Hispanic	Not listed