Student Name

First Name

Last Name

Caregiver Name

First Name

Last Name

Select First Preference

*Denotes board position, which includes one monthly board meeting. Should a family have 2 children in the co-op simultaneously, a board position counts as both required jobs. For more information on job descriptions, please reference the Jobs Document.

Select Second Preference

Select Third Preference

Please note any positions previously held or experience that may lend itself to a certain position:

Job Preferences