Welcome
indicates required fields
Entry point is for students currently in 6th grade to begin in summer before 7th grade.
Who is completing this form?
Parent
Teacher
Counselor
Community Member
Please enter your name here:
Mr.
Mrs.
Ms.
Dr.
Title
First
Last
Jr
Sr
II
III
IV
Suffix
Please enter your name here:
Mr.
Mrs.
Ms.
Dr.
Title
First
Last
Jr
Sr
II
III
IV
Suffix
How can we help you today?
I would like to:
Inquire
Inquire about or Attend a Family Information Meeting (FIM)
Tell us more:
Attend a Family Information meeting:
Contact for this appointment
First Name
Last Name
Phone
Email
What questions can we answer?
How would you like us to reach out?
Email
Phone
About the Student
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Gender
Date of Birth
mm/dd/yyyy
Current Grade
6th
7th
8th
Interested in Grade
7th
8th
For the Summer of
2025-2026
2026-2027
2027-2028
2028-2029
2029-2030
2030-2031
Current School
Achievement First
Annie Fisher
Batchelder
Bellizzi
Betances
Breakthrough Magnet North
Breakthrough Magnet South
Burns
Burr
Capital Prep
Covenant Prep
CREC Schools (various)
Global Communications Academy
Grace Academy
HMTCA
Jumoke Academy
Kennelly
Kinsella
Mary Hooker
McDonough
Milner
MLK Middle
Museum Academy at Wish
Naylor
Noah Webster
Renzulli
SAND
Rawson
Parkville Community School
West Middle
Other
Current School
About the Parent/Guardian
Name
Mr.
Mrs.
Ms.
Dr.
Title
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Student
Mother
Father
Stepmother
Stepfather
Grandmother
Grandfather
Guardian
Primary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
Secondary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
Email
Mailing Address
Primary Language Spoken at Home
English
Spanish
Cantonese
Mandarin
Albanian
American Sign Language
Arabic
Armenian
Assyrian
Bengali
Burmese
Cebuano
Chaldean
Chamorro
Chaozhou
Dutch
Farsi
French
German
Greek
Gujarati
Hebrew
Hindi
Hmong
Hungarian
Ilocano
Indonesian
Italian
Japanese
Khmer
Khmu
Korean
Kurdish
Lahu
Lao
Marshallese
Mien
Mixteco
Pashto
Pilipino
Polish
Portuguese
Punjabi
Romanian
Russian
Samoan
Serbo-Croatian
Somali
Taiwanese
Tagalog
Thai
Tigrinya
Toishanese
Tongan
Turkish
Ukrainian
Urdu
Vietnamese
Other
Broadening Horizons
Interests
Thanks for reaching out! Out of curiosity...
How did you hear about Hartford Youth Scholars?
Friend
Website
School Visit
Print Advertisement
Current School
Referral
Other
Please specify