BOSS Program Application

Thank you for your interest in joining BOSS. Please put N/A in any fields that are not applicable. Once completed, you will be contacted by a BOSS team member.

Student's First Name *

Nickname

Student's Last Name *

Birth Date *

Parent's Mobile Phone *

Phone 2

Student's Nonschool Email *

Street *

City *

State/Province *

Zip *

School Name ('26-27 School Year) *

School District *

If you selected "Other," please fill in the name of the School District.

Grade Level ('26-27 School Year) *

If you play sports for school, church, or travel clubs, please let us know which sports you play. *

Are you willing to make your academic and personal success as much of a priority as your athletic or other successes? *

Yes

No

Please explain. *

Which type of education plan do you have at school? *

If other, please list *

How did you hear about us? Please provide the person's name, if known. *

Parent/Guardian Full Name *

#1 Parent/Guardian Email *

Emergency Contact Full Name *

Emergency Contact Phone Number: *

Emergency Contact Relationship: *

Participation Agreement *

By submitting this application, I affirm that the facts set forth in my application for participating are true and complete. Thank you for completing this application form and for your interest in participating in our Boss program. All the information recorded above is considered confidential.