Student Name *FirstMiddleLastStudent Age *Student Birth Date *Parent/Legal Guardian Name *FirstLastAddress *Street AddressAddress *City, State & ZipPhone Number *Email *School DistrictOsceola County Public School DistrictOrange County Public School DistrictWould you like to receive monthly school district updates? *YesNoStudent Education Level *3rd - 5th Grader6th - 8th Grader9th - 12th GraderCollege / University Current Grade *Previous State Testing Reading Score *Used to determine tutoring eligibility. (Example: Florida - FCAT)Previous FCAT Math Score *Used to determine tutoring eligibility. (Example: Florida - FCAT)Previous Disciplinary Issues *If none, please indicate with N/A. If so, please explain.Would you like to participate in our mentoring program? *Yes, as a Student/Mentee.Yes, as a Legal Guardian/Mentor.Neither OptionSelect up to two choices.Any known health conditions or allergies of student? *Is/Will student be a first generation college student?YesNoIf a higher-ed Collegiate student, which level are you?FreshmanSophomoreJuniorSeniorSelect one.PhoneSubmit