Intake form

Name *

Email address *

What grade is your child entering?

Does your child have an individualized education plan (IEP)?

What are your child's interests in business and STEM?

What is your preferred method of communication?

Please select at least one option.

Email

Phone Call

Text Message

Do you require before or after-school care?

How did you hear about iLEAD BSTEM?

Please select at least one option.

Social Media

Website

Friend/Family Referral

School Event

Community Event

What is your child’s favorite subject?

Please select at least one option.

Mathematics

Science

Technology

Engineering

Arts

Business

What specific needs or accommodations should we be aware of?

Which service or services are you interested in?

Please select at least one option.

Hands-On curriculum

Individualized education plans

Summer camp programs

Service title 7

Service title 8

Additional questions or comments