Registration

Step 1 of 2: Your Profile

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First Name:

Last Name:

Email Address:

New Password: must be at least 10 characters long

Town or City:

Job Title:

Introduce Yourself in a Sentence:

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Guardian 1 - Full Name:

Guardian 1 - Phone Number:

Guardian 1 - Email Address:

Guardian 1 employer "We collect information from all families to further our community engagement and outreach":

Guardian 2 - Full Name:

Guardian 2 - Phone Number:

Guardian 2 - Email Address:

Guardian 2 employer "We collect information from all families to further our community engagement and outreach":

Scholar alternate email address (if any):

Full Address *:

Zipcode*:

State*:

Name of Current School (official name, no abbreviation):

If your school is outside of the Louisville Metro Area or not listed in the drop down above, please add it here:

Gender*:

Guardians Relation to Scholar:

Guardian, do you consent to the application and participation, creation of account, and Authorization for release/use of Image, Words, or Likeness::

Current School Grade:

If your Scholar is a JCPS student, you MUST copy and paste this link to your browser and complete the following form for your student to participate. https://docs.google.com/forms/d/e/1FAIpQLSc2-Ag3bxDosJ5qAdXbWaQIb7ekm2KBo6YkmuJGczfRbX0UEA/viewform :

Guardians - What social skills do you think your student can improve on?:

Educational Justice free tutoring services are awarded to 5th-8th grade students who are in need of academic tutoring and mentoring, but who are unable to afford such assistance. Select the circumstances that apply to your family:

Have you been a previous EJ participant? If so, how many years?:

How did you learn about Educational Justice ?:

Do you have access to a computer or tablet to attend tutoring sessions?:

In terms of ethnicity, how do you self-identify? (Check all that apply) *:

Other Spoken Languages:

What do you like to read?:

Interests:

Days of the week where you can be available for tutoring sessions between 5 and 9 PM on Weekdays, or 11-6PM on Weekends (Choose at least 2 days):

Month of Birth:

If an individual or an organization referred to EJ program, please provide their full name here::

I have read and understood PushFar's Terms of Use

I have read and understood PushFar's Privacy Policy

Organisation Notice

Educational Justice is located at 200 York Street, Louisville, KY 40203