2024-2025 Catalyst: Bremerton Application for Enrollment Survey

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* 2. What is the first name of your scholar?

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* 3. What is the last name of your scholar?

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* 4. What is the gender of your scholar?

Female

Male

Nonbinary

Prefer not to say

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* 5. What is the date of birth of your scholar?

Date / Time

Date

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* 6. What is your address?

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* 7. What school does your scholar currently attend (or to what neighborhood school would they be zoned)? (optional)

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* 8. Does your child/family currently receive free or reduced lunch or other type of government financial assistance? (optional)

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* 9. Primary ethnicity of scholar (optional - check as many boxes as apply)

African, Black

African American, Black

Asian American

Multi-Ethnic/Multi-Racial

Alaska Native

Latino or Hispanic

Pacific Islander

American Indian

White/Caucasian

Other

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* 10. What language did your scholar first learn to speak? (optional)

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* 11. What language does your child use most at home? (optional)

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* 12. What language does the parent/guardian use the most when speaking to the child (optional)?

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* 13. What is the first name of the primary parent/guardian?

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* 14. What is the last name of the primary parent/guardian?

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* 15. What is the email of the primary parent/guardian?

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* 16. What is the phone number of the primary parent/guardian?

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* 17. What is the primary language spoken of the primary parent/guardian?

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* 18. What is the first name of a second parent/guardian?

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* 19. What is the last name of a second parent/guardian?

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* 20. What is the email of a second parent/guardian?

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* 21. What is the phone number of a second parent/guardian?

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* 22. What is the primary language spoken of a second parent/guardian?

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* 23. How did you hear about Catalyst: Bremerton?

Facebook/Instagram/Social Media

Website

Mailer that came to my home

Friend, family or colleague

If a friend, family member, or colleagued referred you please list their name.

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* 24. Is your scholar the child of a current Catalyst: Bremerton employee?

Yes

What is the staff member's name?

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* 25. Does your scholar have any siblings?

Yes

2024-2025 Catalyst: Bremerton Application for Enrollment

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* 1. What grade is your scholar currently in for the 2024-2025 school year?

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* 2. What is the first name of your scholar?

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* 3. What is the last name of your scholar?

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* 4. What is the gender of your scholar?

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* 5. What is the date of birth of your scholar?

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* 6. What is your address?

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* 7. What school does your scholar currently attend (or to what neighborhood school would they be zoned)? (optional)

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* 8. Does your child/family currently receive free or reduced lunch or other type of government financial assistance? (optional)

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* 9. Primary ethnicity of scholar (optional - check as many boxes as apply)

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* 10. What language did your scholar first learn to speak? (optional)

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* 11. What language does your child use most at home? (optional)

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* 12. What language does the parent/guardian use the most when speaking to the child (optional)?

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* 13. What is the first name of the primary parent/guardian?

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* 14. What is the last name of the primary parent/guardian?

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* 15. What is the email of the primary parent/guardian?

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* 16. What is the phone number of the primary parent/guardian?

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* 17. What is the primary language spoken of the primary parent/guardian?

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* 18. What is the first name of a second parent/guardian?

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* 19. What is the last name of a second parent/guardian?

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* 20. What is the email of a second parent/guardian?

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* 21. What is the phone number of a second parent/guardian?

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* 22. What is the primary language spoken of a second parent/guardian?

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* 23. How did you hear about Catalyst: Bremerton?

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* 24. Is your scholar the child of a current Catalyst: Bremerton employee?

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* 25. Does your scholar have any siblings?