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Enroll in Change: Program Application

Program Application

For program application, please provide the applicant’s personal information, educational background, and a brief statement of interest. Parents or guardians applying for children must include details about the child’s educational needs and any special requirements.

First Name

Last Name

Date of Birth

Address

Phone

Current School/Institution (if applicable)

Grade Level or Equivalent

Statement of Interest

Parent/Guardian Name (If applicant is a Minor)

Relationship to Applicant

Parent/Guardian Phone

Parent/Guardian Email

Special Requirements (if any)

Please Select Each Program of Interest

Enroll in Change: Program Application

Program Application

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