KIDS AT HEART | STUDENT APPLICATION
The Kids at Heart (KAH) Program provides tutoring and mentoring for low-income children in grades 1-12. Please complete this application in its entirety. Once submitted, the Kids at Heart Programs Manager will reach out to you to schedule a student assessment for your child. If you are enrolling multiple children into the program, please submit multiple applications. To
participate in the program, your household must have WIFI and access to a laptop or tablet.

Student Information | MUST COMPLETE ALL REQUIRED FIELDS

Current tutoring status at UPLIFT
IF RETURNING: Would student like to be placed with the same tutor worked with most recently?

Guardian Information | MUST COMPLETE ALL REQUIRED FIELDS

Emergency Contact Information | MUST COMPLETE ALL REQUIRED FIELDS

Terms and Eligibility (For Guardian Completion)

I agree to the following:

Terms and Eligibility (For Student Completion)

I agree to the following:

Thank you for applying! Keep an eye on your email inbox for a message from our Program Manager.