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Parent Application

Please Note: Once you begin the application process you must complete the section and hit submit. You cannot save your changes and come back later to finish. You may look the application over and gather the information you need before you start.

Personal Data

Parent or legal guardians.
Please list the adult with whom the applicant lives regularly.

Applicant Information

Transportation

Work History and Job Experiences

Do you feel that any of the following tasks might be difficult for your son or daughter?

By clicking submit: I understand that if my son/daughter is accepted into this program, they will need to complete a health screening through Employee Health at Summa Health System. Prior to doing so, they will need the following vaccinations: 2 MMRs and 2 variccella . Part of the screening process is a TB test that must be done 30 days prior to program entrance and must be done at Employee Health at Summa Health. All participants are required to receive a flu shot in the fall.

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Options to Request an Appointment

If your situation is an emergency, call 911.