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New Participant for Sunbeams
Name
Age
Grade
Select an option...
Pre K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Gender
Female
Male
Race/Ethnicity
Select an option...
American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White or Caucasian
Multi-Racial
Is this your first time in the Rainbows program?
No
Yes
Does this participant receive free or reduced lunch at school?
Select...
Yes
No
I don't know
I prefer not to respond
This helps us receive need-based scholarship funding for sites. Please answer to the best of your knowledge without making anyone uncomfortable.
What type of loss are you dealing with? (please select all that apply)
Death of a parent or loved one
Parents’ divorce or separation
Military deployment of a parent or loved one
Incarceration of a parent or loved one
Deportation of a parent or loved one
Abandonment of a parent or loved one
Life-threatening illness of a parent or loved one
Other
Descripition
Create
Rainbows for All Children
|
614 Dempster Street, Suite C
|
Evanston, IL 60202
|
Phone: (847) 952-1770
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