SLI App – Parent/Guardian Supplement

QR Code for Parent Form Share this application using this QR code or click here to send it via email.(note: works on mobile devices only)

Summer Law Institute Parent/Guardian Information Form

This form must be completed by a parent or guardian for us to consider their student a candidate for selection for the Summer Law Institute.

If you have any questions, contact us at [email protected] or (718) 752-0222 ext. 208. You can also find out more about the SLI by going to our website, www.legaloutreach.org/SLI

1. Student First Name:

2. Student Last Name:

3. Email:

4. Phone Number:

5. Best Time of Day to Contact

6. Home Address (of Student):
Include your apartment number with your street adress.
For example: 3614 35th Street Apt 1A, New York, NY 11106

7. Borough (of Student):

8. Neighborhood (of Student):

Student’s Parent/Guardian 1 Info

9. Parent 1’s or Guardian’s Name:

10. Parent 1’s or Guardian’s Relationship to Student:

11. Parent 1’s or Guardian’s EmploymentStatus

12. Parent 1’s or Guardian’s Job

13. Parent 1’s or Guardian’s highest level of education (even if outside of U.S.):

College/Institute Name

14. Parent 1’s or Guardian’s Ethnicity:
Choose the one you most consider yourself to be.

15. Parent 1’s or Guardian’s country of birth:if not US, also indicate # of years in US (this is for data collection only and is NOT reported to external organizations)

16. Parent 1’s or Guardian’s primary languages?(please check all that apply)

Only if Other, please write the language you speak at home.

Student’s Parent/Guardian 2 Info

17. Parent 2’s or Guardian’s Name:
Write “NA” if not available.

18. Parent 1’s or Guardian’s Relationship to Student:

19. Parent 2’s or Guardian’s Employment Status

20. Parent 2’s or Guardian’s Job

21. Parent 2’s or Guardian’s highest level of education (even if outside of U.S.):

College/Institute Name

22. Parent 2’s or Guardian’s Ethnicity:
Choose the one you most consider yourself to be.

23. Parent 2’s or Guardian’s country of birth:if not US, indicate # of years in US (this is for data collection only and is not reported to external organizations)

24. Parent 2’s or Guardian’s primary languages?(please check all that apply)

Only if Other, please write the language you speak at home.

Housing/Financial Information

25. Please indicate which type of housing in which the student currently lives:

If house/apartment is owned, when was the house/apartment purchased?

26. Household Gross Adjusted Income ($) (If you have questions regarding why we ask for this, please email [email protected]!)

27. Please indicate whether the above is an estimate or can be verified on your 1040:

28. Number of people in the household (including yourself and the student):

29. List all of the people who live in your household (including yourself and the student). Please write each person’s name, occupation, and relationship to student.

Additional Helpful Information

30. Does the student currently have, or has the student ever been evaluated for, an IEP (Individualized Education Plan) or Section 504 Plan? If YES, please email a copy of the IEP/504 to [email protected].

31. Is the student currently participating in, or has the student ever participated in an ESL (English as a Second Language) program?

32. Is your student related to a student who has participated in a program with Legal Outreach?

33. If you answered “yes” to the previous question, please enter the name of the other student and his/her relationship to your child (e.g., brother, cousin, etc.):

34.

35.

This form will not submit unless all required questions have been answered. Follow the directions for each question. Some you can skip and some require you to write “NA” if you can not answer it. If you have any issues e-mail [email protected].