After School Interest Form

If you are interested in our after school program, please fill out the form below. The first step in our application process is submitting an interest form so that we can verify with your child’s school that they qualify for our program. Once we receive a completed interest form, we will follow up with you via email.

This is not our registration form. If you received a letter from your child’s school, you will need to follow the instructions in the letter to access the registration form. Please TYPE in the web address exactly how it is on the letter.

Esta página se puede traducir al español. Si necesita traducir este formulario al español, desplácese hasta la parte inferior de la página y busque el cuadro “traducir”. Seleccione español de la lista para que la página se traduzca al español.

Este no es nuestro formulario de registro. Si recibió una carta de la escuela de su hijo, deberá seguir las instrucciones de la carta para acceder al formulario de inscripción. Por favor, ESCRIBE la dirección web exactamente como está en la carta.

"*" indicates required fields

Child's Name*

First Last Suffix

School*

2024-25 Grade*

Grade your child will be in the 2024-2025 school year

Wait List

Currently we do not have any openings in your child’s grade and/or school and have started a wait list. If you are interested in being added to the wait list, you can complete this form and we will check their eligibility.

If they are eligible, we will send you a registration form. Your child will not be added to the wait list until we receive the registration form.

I understand

Does your child qualify for free or reduced lunch?*

Yes

Does your child have an Individualized Education Program (IEP)?*

Yes

Part of our interest form is signing the Wake County Public School System Parent/Guardian Consent For Release and Exchange of Information. By signing this, you are authorizing Community of Hope Ministries to obtain a copy of your child’s IEP. We do this to help make sure we will be able to provide the support they need.

Child's Gender*

Parent/Guardian's Name*

First Last

Phone*

Email*

Enter Email Confirm Email

Primary Language Spoken*

English

Spanish

Other

WCPSS Release and Exchange of Information

This consent is for the release and exchange of information for the purpose of sharing information on my child’s educational performance in the Wake County Public School System (WCPSS), to include his or her academic achievement and social-emotional development. The purpose of releasing and exchanging this information is to assist individuals to plan and provide a high quality after school educational program for my child. Individuals who WCPSS personnel can share this information in accordance with this release are limited to those involved in implementing Community of Hope Ministries.

I hereby authorize WCPSS personnel to release and exchange specified information concerning my child’s educational performance with personnel associated with the above named agency. I understand that this information is to be used by personnel at the agency in planning and delivering educational, social-emotional, and recreational services to my child in the COHM after school program. By signing below I am allowing the following:

a. Discussions with my child’s WCPSS school teacher(s) and other staff (e.g., administrators, specialists, counselors), as well as review of surveys about my child completed by these school staff;
b. Data on my child’s report card grades, results of End-of-Grade and End-of-Course exams, and other group examinations;
c. Other information that may be found in my child’s records at school, including his or her Individualized Education Program (IEP), his or her attendance at school and disciplinary incidents at school;

The doctrine of informed consent has been explained to me. I understand the nature of the information to be released, the need for this information and use which will be made of this information, and that there are statutes and regulations requiring recipients of this information to maintain the confidentiality of the information and use it only for its intended purposes in the COHM program. I hereby acknowledge that this consent is truly voluntary, and understand the consent will expire automatically on June 30, 2025. I further acknowledge that I may revoke this consent in writing at any time except to the extent that action based on this consent has been taken.

Signature*

I agree to allow WCPSS to release information to COHM for the purposes of checking eligibility.

After School Interest Agreement*

By checking the box below, I understand that submitting this form does not qualify my child or secure my child a spot in the after school program at Community of Hope Ministries.

I understand and agree

Comments

This field is for validation purposes and should be left unchanged.

After School Interest Form

WCPSS Release and Exchange of Information

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