E3 Student Registration

E3 — Encourage, Educate, Empower supports refugee high school students through academic mentorship and financial incentives for maintaining good grades.

Contact Information

Parent/Guardian Full Name *

Parent/Guardian Phone *

Email *

Existing Client

Has your family received services from Ethaar before? *

YesNo, this is my first time

Parent / Guardian

The parent or guardian will be the primary contact for this enrollment.

Home Address *

Street Address

Apt / Unit

City

State

ZIP Code

Student Information

Tell us about the student being enrolled in E3.

Student first name *

Student last name *

Student date of birth *

Student gender *

Your relationship to the student *

Academic Information

School Name *

Grade Level *

Semester applying for *

Most recent GPA (if available)

Academic Records

Most recent report card or transcript*

Program Rules & Agreement

The following legal text is provided in English only for accuracy and will not be translated.

By enrolling in the E3 program, the parent/guardian agrees to: • Ensure the student attends all scheduled sessions • Communicate any absences in advance • Support the student's academic progress at home • Attend parent meetings when scheduled • Notify Ethaar of any changes in contact information

I have read and agree to the program rules above. *