YOUTH INTAKE FORM
Please direct any questions to:
Email
: info@multiculturalfamilies.org
Phone:
253.216.4479
Which Program are you registering for?
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BSK Pathways 2 Graduation
BSK SOWA
BSK SOWA Friendship Circle
City of Seattle HOPE
UWKC Love and Liberation (Kickstart)
RSA Youth Leadership Council
SOWA Friendship Club
CONTACT INFORMATION
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ADDRESS INFORMATION
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DEMOGRAPHIC INFORMATION
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Race
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American Indian or Alaska Native
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Grade Level
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Acceleration Academy
Adams Elementary School
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Alternative Spcl Needs Div Occ
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Apollo Elementary
Arbor Heights Elementary School
Ardmore Elementary School
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Aylen Jr High
B F Day Elementary School
Bailey Gatzert Elementary School
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Ballard High School
Ballou Jr High
Bates Technical College - Open Doors
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Beachwood Elementary School
Beacon Hill International School
Beaver Lake Middle School
Bell Elementary
Bellevue Big Picture School
Bellevue Digital Discovery
Bellevue High School
Bennett Elementary School
Benson Hill Elementary School
Bethel Elementary Learning Academy
Bethel High School
BETHEL HOPE EARLY LEARNING CENTER
Bethel Middle School
Bethel Virtual Academy
Beverly Park Elem at Glendale
Big Picture School
Birney Elementary School
Black Diamond Elementary
Blackwell Elementary
Blix Elementary School
Bonney Lake Elementary
Bonney Lake High School
Bow Lake Elementary
Boze Elementary School
Briarwood Elementary
Bridges Transition
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Broadview-Thomson K-8 School
Brookdale Elementary
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Browns Point Elementary School
Bryant Elementary School
Bryant Montessori Middle School
Bryant Montessori School
Bryn Mawr Elementary School
Byron Kibler Elementary School
Camas Prairie Elementary
Campbell Hill Elementary School
Canyon Ridge Middle School
Career Academy at Truman High School
Career Link
Carriage Crest Elementary School
Carson Elementary
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Cascade Elementary School
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Central Educational Services
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Chester H Thompson Elementary
Chief Leschi Schools
Chief Sealth International High School
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CHOICE Academy
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Cleveland High School STEM
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Collins Elementary
Columbia Junior High School
Comm Based Trans Program
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Creekside Elementary
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Curtis Junior High
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Daffodil Valley Elementary
Daniel Bagley Elementary School
David T. Denny International Middle School
Dearborn Park International School
Decatur Elementary School
Decatur High School
Delong Elementary School
Dessie F Evans Elementary
Dimmitt Middle School
Discovery Elementary
Discovery Primary School
Discovery School
Downing Elementary School
Dr. Dolores Silas High School
Dropout Prevention and Reengagement Academy
Drum Intermediate
Dunlap Elementary School
Dynamic Family Services
East Hill Elementary School
Eastlake High School
Eckstein Middle School
Edgerton Elementary
Edison Elementary School
Edna Travis Elementary School
Edwin R Opstad Elementary
Eismann Elementary
Elk Plain School of Choice
Ella Baker High School (Open Doors)
Elmhurst Elementary School
Emerald Hills Elementary
Emerald Park Elementary School
Emerald Ridge High School
Emerson Elementary School
Emerson High School
Emerson K-12
Employment Transition Program
Enatai Elementary School
Endeavour Elementary School
Enterprise Elementary School
Enumclaw Middle School
Enumclaw Sr High School
Environmental & Adventure School
Evergreen Elementary
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Evergreen Primary
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Fawcett Elementary School
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Federal Way Public Academy
Federal Way Running Start Home School
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Ferrucci Jr High
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Fife Open Doors
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Firgrove Elementary
First Creek Middle School
Foss High School
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Franklin Elementary
Franklin Elementary School
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Franklin Pierce High School
Frantz Coe Elementary School
Frederickson Elementary
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Gateway to College
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Geiger Montessori School
Genesee Hill Elementary
George T. Daniel Elementary School
Gibson Ek High School
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Grad Alliance Program
Graham Hill Elementary School
Grand Ridge Elementary
Grant Elementary School
Grass Lake Elementary School
Gray Middle School
Green Gables Elementary School
Green Lake Elementary School
Greenwood Elementary School
Gregory Heights Elementary
Griffin Home
H.O.M.E. Program
Hamilton International Middle School
Harvard Elementary
Hawthorne Elementary School - Seattle
Hazel Valley Elementary
Hazel Wolf K-8
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Hazen Senior High School
Helen Stafford Elementary School
Highland Middle School
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Highlands Elementary School
Highline High School
Highline Home School Center
Highline Open Doors 1418
Highline Public Schools Virtual Academy
Hillside Elementary School
Hilltop Elementary
Hilltop Heritage Middle School
Honey Dew Elementary
Horizon Elementary School
Hunt Elementary
Hunt Middle School
iGrad
Illahee Middle School
Impact | Black River Elementary
Impact | Commencement Bay Elementary
Impact | Puget Sound Elementary
Impact | Salish Sea Elementary
Industrial Design Engineering and Arts
Inglewood Middle School
Ingraham High School
Insight School of WA Open Doors Program
Interagency Detention School
Interagency Open Doors
Interagency Programs
Interlake Senior High School
International Community School
International School
Internet Academy
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Issaquah High School
Issaquah Middle School
Issaquah Special Services
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James Baldwin Elementary School
James Sales Elementary
Jane Addams Middle School
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Jing Mei Elementary School
JJ Smith Elementary
John Hay Elementary School
John Muir Elementary School
John Rogers Elementary School
John Stanford International School
Juanita Elementary
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Kent Laboratory Academy
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Kimball Elementary School
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Lawton Elementary School
Leschi Elementary School
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Liberty Ridge Elementary
Liberty Sr High School
Licton Springs K-8
Lincoln High School
Lindbergh Senior High School
Lister Elementary School
Louisa Boren STEM K-8
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Loyal Heights Elementary School
Lyon Elementary School
Madison Middle School
Madrona Elementary
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Magnolia Elementary
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Mann Elementary School
Maple Elementary School
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Maple Lawn Elementary
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Mark Twain Elementary School
Martin Luther King Jr. Elementary School
Martin Sortun Elementary School
Mason Middle School
Mattson Middle School
Maywood Middle School
Mcauliffe Elementary
McClure Middle School
McDonald International School
McGilvra Elementary School
McKnight Middle School
McMicken Heights Elementary
Mead Elementary
Meadow Ridge Elementary School
Meany Middle School
Meeker Elementary
Meeker Middle School
Mercer International Middle School
Mercer Island High School
Meridian Elementary School
Meridian Middle School
Meriwether Elementary School
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Midland Elementary
Mill Creek Middle School
Millennium Elementary School
Mirror Lake Elementary School
Montlake Elementary School
Morris Ford Middle School
Mount Tahoma High School
Mount View Elementary
Mountain View Middle School
Muir Elementary
N.E. Tacoma Elementary School
Naches Trail Elementary
Narrows View Intermediate
Nathan Hale High School
Nautilus K-8 School
Neely O Brien Elementary School
Nelsen Middle School
New Start
Newcastle Elementary Scho
Newport Heights Elementary
Newport High School
Newport Home Link
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North Beach Elementary School
North Bend Elementary School
Northstar Middle School
Northwood Elementary School
Northwood Middle School
Nova High School
Oakland High School
Odle Middle School
Olympic Hills Elementary School
Olympic View Elementary School
Open Door Youth Reengagement Renton
Open Doors at LWIT
Open Doors Youth Reengagement (1418)
Orca K-8 School
Orting Elementary School
Orting High School
Orting Middle School
Out Of District Facility
Pacific Cascade Middle School
Panther Lake Elementary School
Park Orchard Elementary School
Pathfinder K-8 School
Pend Oreille River School
Perry G Keithley Middle School
Phantom Lake Elementary
Pierce County Skills Center
Pine Lake Middle School
Pine Tree Elementary School
Pioneer Valley Elementary
Point Defiance Elementary School
Pope Elementary
Private School Services
PSD Special Services
Ptarmigan Ridge Elementary School
Puesta del Sol Elementary School
Puget Sound High School
Puget Sound Skills Center
Puyallup High School
Puyallup Online Academy/POA
Puyallup Open Doors/POD
Puyallup Parent Partnership Program
Queen Anne Elementary
Rainier Beach High School
Rainier Elementary School
Rainier Prep
Rainier Valley Leadership Academy
Rainier View Elementary School
Raisbeck Aviation High School
Reed Elementary School
Regional Justice Center
Remann Hall Juvenile Detention Center
Renaissance School
Renton Academy
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Renton Remote School
Renton Senior High School
Renton Technical High School
Residential Consortium
Ridgecrest Elementary
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Rising Star Elementary School
River Ridge Elementary
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Rock Creek Elementary
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Roosevelt High School
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Sacajawea Elementary School
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Sadie Halstead Middle School
Salmon Bay K-8 School
Sammamish Senior High
Sand Point Elementary
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Sartori Elementary School
Satellite High School
Sawyer Woods Elementary School
Scenic Hill Elementary School
Science and Math Institute
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Seattle Skills Center
Seattle World School
Shadow Lake Elementary
Shaw Road Elementary
Sheridan Elementary School
Sherman Elementary School
Sherwood Forest Elementary
Sherwood Forest Elementary School
Shining Mountain Elementary
Shorewood Elementary
Showalter Middle School
Sierra Heights Elementary School
Silver Lake Elementary School - Federal Way
Skyline Elementary School
Skyline High School
Smith Elementary
Somerset Elementary School
Soos Creek Elementary School
South Shore PK-8 School
Southern Heights Elementary
Southwest Youth and Family Services
Southwood Elementary School
Spanaway Elementary
Spanaway Lake High School
Spanaway Middle School
Special Ed School
Special Services
Spinning Elementary
Spiritridge Elementary School
Springbrook Elementary School
Stadium High School
Stahl Junior High
Stanley Elementary School
Star Lake Elementary School
Stevens Elementary School
Stevenson Elementary
Stewart Elementary
Stewart Middle School
Stratton Elementary
Summit Public School: Atlas
Summit Public School: Olympus
Summit Public School: Sierra
Sumner High School
Sumner Middle School
Sunny Hills Elementary
Sunnycrest Elementary School
Sunrise Elementary
Sunrise Elementary School
Sunset Elementary
Sunset Primary
Support School
Surprise Lake Middle School
Sylvester Middle School
Tacoma Online Elementary School
Tacoma Online High School
Tacoma Online Middle School
Tacoma Open Doors
Tacoma Pierce County Education Center
Tacoma School of the Arts
TAFA at Saghalie
Tahoma Elementary
Tahoma Open Doors
Tahoma Senior High School
Talbot Hill Elementary School
Talley High School
Tehaleh Heights Elementary
The Center School
The Outreach Program
The School at Pearl Youth Residence
Thoreau Elementary
Thorndyke Elementary
Thornton Creek Elementary School
Thunder Mountain Middle School
Thurgood Marshall Elementary
Tiffany Park Elementary School
Tillicum Middle School
Todd Beamer High School
Tops K-8 School
Truman Middle School
Tukwila Elementary
Tukwila Online Learning
Twain Elementary
Twin Falls Middle School
Twin Lakes Elementary School
Tyee High School
Tyee Middle School
University Place Primary
Victor Falls Elementary
View Ridge Elementary School
Viewlands Elementary School
Wainwright Intermediate School
Walker High School
Waller Road Elementary
Washington Elementary School
Washington High School
Washington Middle School
Wedgwood Elementary School
West Mercer Elementary
West Seattle Elementary School
West Seattle High School
West Woodland Elementary School
Westwood Elementary School
White Center Heights Elementary
Whitman Elementary School
Whitman Middle School
Whittier Elementary School
Wildwood Elementary
Wildwood Elementary School
Wing Luke Elementary School
Woodland Elementary
Woodridge Elementary
Youthsource
Zeiger Elementary
Other School
Expected graduation date
Primary Language
Please select...
Amharic
Arabic
ASL
Bengali
Cantonese
Communication device
Dari
English
German
Hindi
Japanese
Khmer
Korean
Kurdish
Mandarin
Non-verbal
Oromo
Other
Persian (Farsi)
Polish
Portugese
Punjabi
Russian
Somali
Spanish
Swahili
Tagalog
Taiwanese
Tigrinya
Ukrainian
Vietnamese
Other Primary Language
Do you need an interpreter
Please select...
Choice A
Choice B
Choice C
Secondary Language
Please select...
Amharic
Arabic
ASL
Bengali
Cantonese
Communication device
Dari
English
German
Hindi
Japanese
Khmer
Korean
Kurdish
Mandarin
Non-verbal
Oromo
Other
Persian (Farsi)
Polish
Portugese
Punjabi
Russian
Somali
Spanish
Swahili
Tagalog
Taiwanese
Tigrinya
Ukrainian
Vietnamese
Other secondary language
Do you have a disability?
Yes
No
What is/are your disability/disabilities?
Please list any current allergies you may have
INCOME INFORMATION
Using the chart above, what is your household income category?
Please select...
Extremely Low (30% HUD PMSA)
Very Low (50% HUD PMSA)
Low (80% HUD PMSA)
Unknown
Number of household members
Free/Reduced Lunch
Yes
No
Parent Information
Parent First Name
Parent Last Name
Parent Email
Parent Phone
Preferred method of contact
Please select...
Text
Email
Phone
Other
MEDIA RELEASE
I hereby give my permission for ODMF to use my child’s photograph/image in its various marketing publications or other media.
I agree
Yes
No
Date
Participant Signature
Contact Information