September 2022

Student Name*
First Last
Preferred Name or Nickname
Gender
- Male
- Female
- Non-Binary
Pronouns
- he/him/his
- she/her/hers
- they/them/theirs
Student Birth Date*
Current School Grade
Current School Attending
Do you know of any other families or students that might be interested in EKUSO? Provide their name(s) and contact information below, and we’ll reach out!
Parent Information
Parent/Guardian Name*
Parent/Guardian Email Address*
Relationship to Applicant*
- Mother
- Father
Primary Phone
Is there anything else we should know in regards to your child? (their learning habits, health conditions, behavioral insight, etc?)