2020-21 High School & College Success Program Enrollment Please fill out the form below to enroll in the 2020-21 High School & College Success Programs. Deadline: June 1, 2020 2020 HS & College Program Enrollment Parent/Guardian Name* First Last Parent Email* Family Address (address where student lives)* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Best Phone Number for Parent/Guardian*Student #1Name of Horizons Student (1)* First Last Student 1 Email* Student 1 Cell PhoneStudent 1 Current Grade*Click to select grade8th9th10th11th12thCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorCollege Year 5 or 6Student 1 Current School*Name of School Student 1 Will Attend in School Year 2020-2021Is Student 1 Returning to Horizons in 2020-2021?* Yes No Student 1 T-Shirt SizeClick to select sizeadult smalladult mediumadult largeadult x-largeadult xx-largeStudent #2Name of Horizons Student (2) First Last Student 2 Email Student 2 Cell PhoneStudent 2 Current GradeClick to select grade8th9th10th11th12thCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorCollege Year 5 or 6Student 2 Current SchoolName of School Student 2 Will Attend in School Year 2020-2021Is Student 2 Returning to Horizons in 2020-2021? Yes No Student 2 T-Shirt SizeClick to select sizeadult smalladult mediumadult largeadult x-largeadult xx-largeStudent #3Name of Horizons Student (3) First Last Student 3 Email Student 3 Cell PhoneStudent 3 Current GradeClick to select grade8th9th10th11th12thCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorCollege, Year 5 or 6Student 3 Current SchoolName of School Student 3 Will Attend in School Year 2020-2021Is Student 3 Returning to Horizons in 2020-2021? Yes No Student 3 T-Shirt SizeClick to select sizeadult smalladult mediumadult largeadult x-largeadult xx-LargeStudent #4Name of Horizons Student (4) First Last Student 4 Email Student 4 Cell PhoneStudent 4 Current GradeClick to select grade8th9th10th11th12thCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorCollege Year 5 or 6Student 4 Current SchoolName of School Student 4 Will Attend in School Year 2020-2021Is Student 4 Returning to Horizons in 2020-2021? Yes No Student 4 T-Shirt SizeClick to select sizeadult smalladult mediumadult largeadult x-largeadult xx-largeReason For WithdrawalIf your Horizons student(s) will not be returning for the2020-2021 school year, please let us know the reason in the space below.Parent or Legal Guardian Signature*Date* Date Format: MM slash DD slash YYYY
