Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Race/Ethnicity

Black/African American

Hispanic

Native American

White

Other

Prefer Not to Say

Cell Phone *

(###)

###

####

Other Phone

(###)

###

####

Physical Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address (If Different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent and/or Legal Guardian Name

First Name

Last Name

Phone Number of Parent and/or Legal Guardian

(###)

###

####

I give permission to Wayfinder Schools to contact my former school and discuss my application and further enrollment with Wayfinder Schools. *

Yes

No

Child's Date of Birth

MM

DD

YYYY

Other Birth Parent's Name

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

Other Birth Parent's Name

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

Other Birth Parent's Name

First Name

Last Name

How did you hear about Wayfinder Schools Passages Program?

Referral (please list below)

Friend (please list below)

Counselor

FedCap

Online

Other (please list below)

Have you experienced, or are you currently experiencing any of the following? Check all that apply. *

Homelessness

Food Insecurity

Neither

Which agencies and/or programs are you involved with?

TANF/ASPIRE

Teen Parenting Program

WIC

MECare

Other

Are you currently employed? *

Yes

No

Wayfinder Schools complies with the Veterans Benefits and Transition Act of 2018, section 3679 of Title 38. Please let us know if you are entitled to Education Assistance under Chapter 31 Vocational Rehabilitation and Employment, or Chapter 31, Post 9/11 GI Bill Benefits. *

Yes, I am entitled to Education Assistance under Chapter 31 Vocational Rehabilitation and Employment, or Chapter 31, Post 9/11 GI Bill Benefits.

No, I am not entitled.