School in 2022-2023* Please enter the name of the school that this student will be attending the upcoming school year.
If you would like to provide any other details about this student's race, please enter it here: For example:
-White or Caucasian: If this student is Middle Eastern or Jewish and wishes to specify.
-Black or African American: If this student wishes to list a specific diasporic community.
-Asian or Asian American: If this student wishes to list a specific community.
-Native American or Alaska Native: If this student wishes to list a specific tribal affliation.
Health Insurance Company Health insurance information is not required, but helpful for GTCYS to have on file in case of emergency.
Please list all medications that the student requires, including purpose, name, dosage, and frequency. Should any of these be kept with the student? Do any require administration on an emergency basis? If so, describe.* If this does not apply, please enter "none."
Please describe any medical conditions including any physical, emotional, behavioral, or mental health conditions. Please be specific.* If this does not apply, please enter "none."