CAP Self-Nomination Form

Child Advancement Project (CAP) Self-Nomination Form

Please note: You will need to get a parent permission slip signed and returned to the BHS CAP Coordinator before you can be matched with a CAP Mentor. You will also be asked to sign a contract that asks you to follow a few simple rules in order to participate in the CAP program (e.g. no driving, check-in with your teacher before leaving class, etc.).

Name*

First Name

Last Name

What Middle School did you go to?*

CJMS SMS

Other:

Age*

Grade*

Parent/Guardian Name*

First Name

Last Name

Additional Parent/Guardian Name

First Name

Last Name

Have you ever participated in CAP before?*

Yes No

Academic Needs*

Math Geometry Reading/English Physical Science Biology Chemistry General Study Skills Social Studies World Language

Check all that apply.

Please specify what world language you are studying:

Other Needs

Please note if there are other goals you would like to work towards with your CAP Mentor

Are you willing to meet during lunch?*

Yes No

CAP Matches meet one time per week.