Short Course Application

For more information contact Short Courses coordinator Patrick Ryan at patrick.ryan@perkins.org 617-972-7812.

Full payment or written authorization from your funding source must be received at least 2 weeks in advance of a program


Programs

Please check which program(s) you are applying for:


Student Contact Information


Parent/Guardian Contact Information

Primary Parent/Guardian

Additional Parent/Guardian


Vision Teacher Contact Information


State Counselor Contact Information


Questions

What grade level is student functioning at for:

(We are not able to give shots during any of these programs)